A recent study in the United States has revealed that many patients suffering from depression who are high utilisers of medical services, will respond well to treatment afforded by physicians who consult closely with psychiatrists.
According to Dr David Katzelnick of the University of Wisconsin, closer working relationships between physicians and psychiatrists can bring about effective treatment programmes and enhance treatment compliance among patients. “The driving concept should be that primary care physicians regard psychiatrists and other mental health professionals as they do other specialists for other diseases, such as gastroenterologists for non-healing ulcers”, says Dr Katzelnick.
In a pilot research study conducted at two primary care clinics in the United States, the financial benefits of closer liaison between medical professionals have been highlighted, both for patients and medical aid and insurance companies. It was found that primary care physicians who asked for increasing levels of psychiatric support (depending on patient response), were able to effectively halve the utilisation of medical services by depression patients with a history of high medical service use.
Of a screening sample of 100 000 patients, 10 461 were defined as high utilisers of medical services (averaging seven to eight visits to medical service providers each year). Of the high-utilisers, 14% suffered from major depression. The research study involved randomly assigning patients into a depression management program or merely informing them of their diagnosis. The depression management program made use of primary care physicians to diagnose and treat patients with antidepressants for ten weeks. After ten weeks, if there were no signs of improvement, the physician consulted with a psychiatrist – if improvement continued to be unsatisfactory, patients were referred to psychiatrists for further treatment. The program also included a co-ordinator who ensured that patients filled prescriptions and attended follow-up visits, and also made use of extensive educational material in the way of books and videos. After six months of follow-up, the proportion of patients treated in the management program who remained in remission was significantly higher than those not treated in the program.
In another study, it was discovered that elderly patients with chronic medical problems make greater use of health care resources and services if they suffer from depression, according to Dr Jürgen Unützer of Seattle University in the USA.
Based on a four year survey of 2558 elderly patients in a large health maintenance organisation, results indicate that costs in all areas of medical care are higher for depressed patients, regardless of the severity of their physical illnesses. At the start of the study, the overall health-care costs of patients with significant self-reported depression symptoms averaged almost R90,000, compared to the R60,000 medical costs incurred by patients without depressive symptoms. The depressed group utilised more services in all categories of medical care, including outpatient visits, prescriptions and laboratory tests. Specialty mental health care accounted for only 1% of costs.
Investigators have speculated that depression amplifies patients’ physical symptoms – including pain, medication side-effects – and often leads to inadequate nutrition, all of which substantially increase both the use and cost of medical services.
The results of the study have shown that the total economic impact of depression remains largely underestimated, and have raised the alarm for depression to be suitably diagnosed and treated as a matter of urgency.