Few Primary Care Depression Diagnoses Garner Mental Health Specialist Referrals

Fewer than 10% of patients diagnosed with major depressive disorder (MDD) or another type of depression in a primary care setting received a referral to a mental health specialist over 3 years of follow-up, according to a poster presented at Psych Congress 2020.

The finding stemmed from a retrospective analysis of electronic health records for 448,179 primary care patients grouped into 4 cohorts: no depression, clinical evidence of depression, a diagnosis of any depression type other than MDD (non-MDD depression diagnosis), and MDD diagnosis. The poster focused primarily on the 7760 patients diagnosed with non-MDD and the 22,970 diagnosed with MDD during the study period.

“Primary care providers (PCPs) are often the first point of contact and are among the most common providers of care for this patient population,” researchers wrote. “Hence, it is important to understand the real-world practices of PCPs around detection, treatment, and follow-up care for depression, including MDD, to identify opportunities for improvement.”

At the initial appointment with evidence of a depression diagnosis, a larger proportion of patients with MDD received a prescription for any medication, and specifically for an antidepressant, compared with patients with non-MDD depression. At that point, mental health referrals were rare, but more patients with MDD received them compared with patients with non-MDD, according to the poster. In addition, patients with MDD were more often also diagnosed with anxiety or generalized anxiety disorder at the time of depression diagnosis.

After receiving a diagnosis of MDD compared with non-MDD depression, patients were more likely to have follow-up visits with a mental health specialist and less likely to have visits only with a PCP, researchers reported. Compared with patients with non-MDD, those with MDD had a greater number of urgent care visits, emergency department visits, and inpatient admissions the first year after diagnosis.

“Patients with MDD were more likely to receive antidepressants and see a mental health specialist compared with patients with non-MDD. However, only a small proportion of patients in either group (<8%) saw a mental health specialist after diagnosis, and most (>84%) were managed exclusively by primary care providers,” researchers wrote in their conclusion. “This could, in part, be due to the way this information was documented in the EHR; future work is needed to explore the use of natural language processing to determine if referrals are captured in progress notes or other nondiscrete EHR fields.”

AbbVie sponsored the study.

—Jolynn Tumolo 

Reference

Azar K, Pressman A, Vaidya S, et al. Characterizing management of depression in a primary care setting. Poster presented at Psych Congress 2020; September 10-13, 2020; Virtual.