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Care for depression in HMO patients aged 65 and older
J Unützer1, G Simon, T R Belin
1Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, California 90024, USA.
Objective:
To examine treatment for depression among older adults in a large staff model health maintenance organization (HMO).
Design:
A 4-year prospective cohort study (1989-1993).
Setting:
Four primary care clinics of a large staff model HMO in Seattle, Washington.
Patients:
A total of 2558 Medicare enrollees aged 65 and older.
Main Outcome Measures:
Treatment of depression was defined as primary care visits resulting in depression diagnoses, use of antidepressant medications, or specialty mental health services.
Main Results:
The older adults in our sample had low rates of treatment for depression, ranging from 4 to 7% in the entire sample and from 12 to 25% among those with probable depressive disorders. Predictors of treatment included female gender, severity, and persistence of depressive symptoms, and severity of comorbid medical illness. Even when patients were treated for depression, the intensity of treatment was very low. Overall likelihood of treatment for depression increased somewhat from 1989 to 1993, but among those treated, the rate of adequate antidepressant use remained below 30%.
Conclusions:
There is still considerable need to improve care for older adults with depression in primary care.