Quality of depression care in a population-based sample of patients with diabetes and major depression.
OBJECTIVE
Major depression occurs in approximately 11% to 15% of patients with diabetes and is associated with poor glycemic control and adverse medical outcomes. This study examined the rates and predictors of recognition of depression among primary care patients with diabetes and comorbid major depression and the quality of depression care provided during a 12-month period.


METHODS
This study used automated utilization, pharmacy, and laboratory data from a health maintenance organization to describe the rate of recognition of depression and quality of care provided for patients with major depression and diabetes in the 12-month period before diagnosis. Major depression was diagnosed based on the Patient Health Questionnaire (PHQ-9) that was included in a mail survey sent to 9063 patients on the Group Health diabetes registry from 9 primary care clinics.


RESULTS
Approximately 51% of patients with major depression and diabetes were recognized as depressed by the health care system. Women were more likely to be recognized (odds ratio [OR] 1.58, 95% confidence interval [CI 1.26-1.97]), as were those with dysthymia (OR 3.44, 95% CI 2.08-5.72), panic attacks (OR 1.55, 95% CI 1.19-2.19), patients with more than 7 primary care visits (OR 1.42, 95% CI 1.06-1.91) and patients reporting poor health (OR 1.62, 95% CI 1.04-2.53). Of the 51% of patients with major depression who were recognized, 43% received 1 or more antidepressant prescriptions but only 6.7% received 4 or more psychotherapy sessions during a 12-month period.


CONCLUSIONS
There were large gaps in both recognition and quality of depression care provided to patients with major depression and diabetes within a health maintenance organization system.
Katon
Wayne J
WJ
Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA. wkaton@u.washington.edu
Simon
Gregory
G
Russo
Joan
J
Von Korff
Michael
M
Lin
Elizabeth H B
EH
Ludman
Evette
E
Ciechanowski
Paul
P
Bush
Terry
T
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D048909:Diabetes Complications / Q000523:psychology*; D019263:Dysthymic Disorder / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D011613:Psychotherapy / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012042:Registries; D012307:Risk Factors; D012647:Self-Assessment; D012737:Sex Factors; D014861:Washington
D000928:Antidepressive Agents