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Monitoring Antidepressant Medication Management

UPMC Health Plan Behavioral Health Services, together with UPMC for Life, monitors three indicators related to antidepressant medication management: Optimal Practitioner Contacts, 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 Health Plan Employer Data and Information Set (HEDIS).

Optimal Practitioner Contacts is defined as having 3 medical visits within 12 weeks after being newly diagnosed with depression and started on an anti-depressant medication. At least one of the follow-up visits must be with a prescribing clinician. Effective Acute Phase Treatment is defined as members remaining on the anti-depressant medications at least 12 weeks and Effective Continuation Phase Treatment is defined as members remaining on the medications at least 6 months. Rates for these measures for the UPMC for Life HMO (Medicare) population are as follows:

Calendar Year	Optimal Practitioner Contacts	Acute Phase Treatment	Continuation Phase Treatment
2004	41.18%	66.67%	54.90%

Barriers to members seeing clinicians frequently enough after being prescribed anti-depressant medications include:

• High caseloads and scheduling difficulties of practitioners.
• Members and practitioners may lack knowledge of treatment guidelines and expectations.
• Members may feel better after starting antidepressant medication and discontinue treatment prematurely.
• Some UPMC for Life members' medication needs are complex and may be difficult for the member to follow.

UPMC Health Plan Behavioral Health Services and UPMC for Life have implemented the following interventions to improve the rate of Optimal Practitioner Contacts:

• 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 at the start of anti-depressant medication treatment.

UPMC Health Plan Behavioral Health Services and UPMC for Life will continue to monitor these antidepressant medication management indicators and develop additional interventions, as needed, to improve these rates.

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