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----------------------------------------------------------------------- HMO Care of Older Depressed Lacking ----------------------------------------------------------------------- NEW YORK (Reuters) -- Elderly patients enrolled in [American] health maintenance organizations (HMOs) who are treated for depression receive fewer visits with mental health professionals than younger patients. Older patients are also more likely to be given tranquilizers than newer antidepressant medications, according to a new study. While the study did not compare the quality of managed care to private insurance, the findings indicate a need for improvement in HMO treatment of elderly people with depression. "The purpose of this study... was to compare the treatment of older versus younger persons in primary care HMO settings," says study lead-author Dr. Stephen J. Bartels, associate professor of psychiatry at Dartmouth Medical School, Lebanon, New Hampshire. "It was not to compare the care of depression among older persons with HMOs to people without HMOs." The study looked at patients at six HMOs. Of more than 9,000 patients with one or more of the most common primary care diagnoses -- arthritis, asthma, ear infections, stomach pain or ulcers, and high blood pressure -- the researchers identified 1,286 who also were treated for depression. They found that older patients were just as likely to be referred for psychiatric care. But why older patients received almost 40% fewer visits with mental health specialists remains unclear, Bartels says. "It may be that older persons just are less willing to continue through with specialty treatment or less interested. "When you look at other specialty visits, like with cardiologists and rheumatologists, they're getting much more treatment." The study also found that 49% of patients over age 65 with depression were treated with tranquilizers, namely benzodiazepines, compared with 33% of patients under age 65. In addition, "Older adults in our study were four times as likely (16.1%) as younger adults (4.4%) to receive benzodiazepines as the only treatment for diagnosed depression," write the researchers in the International Journal of Psychiatry in Medicine. Bartels notes that benzodiazepines "tend not to be good treatments for depression." These drugs may, in fact, be less safe for the elderly because they increase the risk of falls and confusion. The researchers found that when antidepressants were prescribed, patients over age 65 were more likely to be on older antidepressants, such as the tricyclic antidepressants. Younger patients were three times more likely to be on newer serotonin reuptake inhibitors (SSRIs), for example Prozac. This is important, says Bartels, "because we know that SSRIs are associated with less side effects among older persons." These include falls, mental confusion, and cardiac problems. In their report, the researchers note that some of the elderly patients may have been taking older antidepressants for a long time. Thus, "people may have been reluctant to change them," Bartels says. "It's just as likely as the possibility that this is a reflection of any sort of active cost-containment mechanism by HMOs." The researcher points out that similar treatment patterns have been identified outside of managed care settings. But he notes that because HMOs have significantly greater access to medication and treatment data on each patient's care, "they are actually in an optimal position to take on the position of monitoring and improving care, and we want to help guide them in that effort." In reporting their study, the researchers note that depression is one of the most common problems among older adults and is associated with limitations in daily functioning, high use of health care services, and high medical costs. Given the study's findings, they conclude that "decreasing inefficient minor tranquilizer use and increasing use of newer antidepressant medications may lead to improved outcomes for older depressed patients." [1997, Reuters Health eLine] <http://www.medscape.com/reuters/wed/t1028-1f.html> SOURCE: The International Journal of Psychiatry in Medicine (1997;27:215-231) ----------------------------------------------------------------------- janet paterson - 50/9 - sinemet/selegiline/prozac - [log in to unmask]