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Depression: Implications for State and Local Healthcare Programs
Coordination & Leadership
Deborah Moran, M.D., Assistant Medical Director, Massachusetts Division of Medical Assistance, Boston, Massachusetts
The State of Massachusetts initiated interventions in two different populations (long-term care patients and primary care patients) to address the problems of depression in that State. The three main areas of concern in the State were:
- The high population of people needing (or receiving) care for depression—about 18 percent of the State's population.
- The large increase in pharmacy and long-term healthcare costs that were allocated to mental health diagnoses.
- The organizational changes in health plans and providers and the impact of managed care on the provision of services to the population needing mental health services.
The goals of these programs were to decrease unnecessary costs and improve quality of and access to care for all members served. The two populations addressed were the long-term care population in nursing homes and the primary care population of elderly patients. The State addressed both populations by identifying and targeting key stakeholders in an effort to establish a partnership to implement the development of a coordinated system to improve care to these populations. The importance of getting key stakeholders' involvement in this process in an effort to secure buy-in for the outreach programs and the importance of using the data available to make recommendations for change were critical to the programs' success. Massachusetts placed a great deal of emphasis on the necessity to establish realistic program goals and build trust and commitment from all stakeholders involved.
Jeste DV, et al. Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next two decades. Arch Gen Psychiatry 1999;56:848-53.
Melfi C, et al. Racial variation in antidepressant treatment in a Medicaid population. J Clin Psychiatry 2000 Jan;61(1):16-21.
Mulsant BH, and Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry 1999;60(suppl 20):30-3.
Treating Major Depression in Primary Care Practice: An update of the Agency for Health Care Policy and Research Practice Guidelines. Arch Gen Psychiatry 1998 Dec;55:1121-7.
Current as of September 2000
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Depression: Implications for State and Local Healthcare Programs. Workshop Brief, User Liaison Program, July 10-12, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/depress/ulpdepr.htm