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Monitoring Antidepressant Medication Management
UPMC Health Plan Behavioral Health Services monitors three clinical indicators related to antidepressant medication management: Optimal Practitioner Contact, Effective Acute Phase Treatment, and Effective Continuation Phase Treatment. To monitor these rates, UPMC Health Plan Behavioral Health Services uses a standard national methodology contained in the Healthcare Effectiveness Data and Information Set (HEDIS).
Optimal Practitioner Contact (OPC) is defined as having 3 follow-up visits within the first 12 weeks of treatment after an initial diagnosis of depression is made and a member is treated with antidepressant medication. One of the follow-up visits must be with a prescribing clinician. Effective Acute Phase Treatment is defined as members newly diagnosed with depression remaining on antidepressant medications for at least 12 weeks.
Effective Continuation Phase Treatment is defined as members newly diagnosed with depression and treated with antidepressants, remaining on the medications for at least 6 months.
Our 2007 calendar year rate for Optimal Practitioner Contacts is 22.7% which is higher than the national HEDIS average of 20.76%. Our 2007 rate for Acute Phase Treatment is 68.71% which is also higher than the national HEDIS average of 60.89%. Lastly, our 2007 rate for Continuation Phase Treatment is 51.12% which is above the national HEDIS average of 45.17%.
Barriers identified include:
- High caseloads and scheduling difficulties for practitioners
- Members and practitioners may lack knowledge of treatment guidelines and expectations
- Primary care physicians may provide a substantial percentage of treatment, but lack knowledge of the appropriate treatment recommendations for depression
- Members may feel better after starting antidepressant medication and discontinue treatment prematurely
UPMC Health Plan Behavioral Health Services has implemented the following interventions to improve the rate of Antidepressant Medication Management:
- Treatment guidelines for depression are made available to practitioners
- Letters that encourage Optimal Practitioner Contacts are sent to practitioners treating members newly diagnosed with depressive disorders
- Care Managers prompt practitioners to schedule at least 3 contacts within 12 weeks of the start of anti-depressant medication treatment
- The Depression Case Management Initiative has been initiated with all UPMC Health Plan PCP groups for identifying members newly diagnosed with depression and providing them with case management services, as well as behavioral health referrals when necessary
- We now have the ability to obtain real-time pharmacy data to identify members who are newly prescribed medication and then direct outreach initiatives at both the provider and the member
UPMC Health Plan Behavioral Health Services will continue to monitor these antidepressant medication management measures and will develop additional interventions to improve these rates.
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