Tuesday, August 25, 2009

New data show depression's stubborn grasp in Minnesota

State clinics reveal their rates of success for treating the mental illness, and the results are sobering.

By MAURA LERNER , Star Tribune

Last update: August 20, 2009 - 9:40 PM
Featured comment

Its fairly obvious Depression isnt the hardest condition to treat, however because of the fact that its a multi-dimensional condition, no one method always … read more works. Anyone who has ever had a SERIOUS depressive episode or such as myself has a long standing history of depression. You cant just pigeonhole it to a prescription based fix, some people actually want someone to talk to... I not saying anyone else posting is wrong or right, but it should be handled on a case by case basis, because the symptoms differ by person. A handful of fluxotein isnt always a broom to sweep the problem away. We're living in a technology based anti-personal society, where peoples feelings of detachment are commonplace. Put down your twitter and hug somebody!

For the first time, Minnesota clinics are publicly reporting their success rates at treating depression. The bad news: Only about 4 percent of patients are considered "in remission" -- or no longer depressed -- after six months of treatment.

Success rates for 54 participating clinics were reported Wednesday by MN Community Measurement, an industry group that tracks health-care quality, and posted on its website, www.mnhealthscores.org.

The top-rated clinic, HealthPartners'-Regions Maplewood, reported that 11 percent of its patients had recovered; six clinics reported zero.

Some of the scores are artificially low because of the difficulty in tracking down patients for follow-up, said Jim Chase, the group's president.

But Chase said he believes this kind of public report card -- the first of its kind for depression care -- will spur clinics to make needed improvements, as it has for diabetes care.

"We think when we make it public, one of the advantages is people see who's doing well," said Chase. "There is research out there that there's a better way to treat patients. We hope by measuring the results that we can drive that change."

The rates were based on how patients responded to a standardized depression questionnaire.

For many reasons, depression has been difficult to treat; many patients stop taking their medications or never fill their prescriptions. A 2003 study found that only one in five people with major depression received adequate care.

In the past few years, dozens of Minnesota clinics have started using a questionnaire, known as the PHQ-9 test, to track the symptoms of depression. It asks patients how often, in the previous two weeks, they've experienced nine common symptoms: from feelings of hopelessness to trouble sleeping to thoughts of harming themselves.

The questionnaire is not universally used, Chase said, but he hopes the new public report card will change that. "What we're expecting is the use rate is going to go up a lot, and that's an important step," he said.

As part of the new program, clinics are supposed to give the test to patients at diagnosis and again six months later, to see if their symptoms improve.

Dr. Michael Trangle, who heads the behavioral health program at HealthPartners, the state's third-largest health insurer and clinic system, said it can be tough to get depressed patients to take the follow-up test, one reason the success rates have been so low. "The cardinal symptoms are not just sadness but a lack of energy, initiative," he said. "It's the quintessential group that doesn't follow up.

"Our system of care as usual is very passive and reactive," Trangle added. "If somebody doesn't schedule an appointment, that's it. We don't reach out." This program, he said, will challenge clinics to stay in touch with those patients and, if they're not getting better, adjust their treatment.

Chase cautioned against reading too much into the initial results. "I don't think you want to interpret it as, gee, only 4 percent are ever getting better," he said. This is just the first step, he said, in an effort to get clinics to start measuring depression care much as they do diabetes care.

He noted that more than 400 Minnesota clinics participate in his group's diabetes scorecard, which tracks how well patients control five key risk factors, such as blood pressure and cholesterol. The success rates have jumped from 4 percent to 19 percent since the clinics started tracking and sharing their results, he said.

Maura Lerner • 612-673-7384

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