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Recognizing and treating depression in primary care can prevent unnecessary hospitalizations and save money

More than 25 percent of primary care patients have a diagnosable mental health disorder (most often anxiety or depression). In many cases, these mental health conditions are not detected or treated. The costs associated with untreated mental disorders in primary care are considerable. For example, the annual health care cost for untreated patients with depression is nearly twice that for patients who do not have depression. Proper diagnosis of these problems can prevent higher health care costs, such as the costs associated with an avoidable hospitalization, according to a study supported by the Agency for Healthcare Research and Quality (HS09397).

The researchers found that patients of primary care physicians (PCPs) who diagnosed the greatest number of mental health disorders among their patients had 9 percent lower overall health care expenditures. Inpatient expenditures were 20 percent lower for these patients, compared with patients of PCPs who diagnosed the smallest number of such disorders.

These findings suggest that detection and treatment of mental health disorders in primary care patients could have a substantial impact on reducing hospital costs. The cost benefit of improved diagnosis may be due to less time and resources spent on medical workup of unexplained medical symptoms such as fatigue, headaches, and stomach aches, which often mask undiagnosed depression, as well as more efficient treatment of mental health disorders.

PCPs who diagnose more mental health disorders in their patients may recognize when unexplained medical symptoms are the result of emotional distress or a mental health problem. They also may be less likely to order unnecessary diagnostic tests, refer patients to specialists, or admit patients to the hospital. For example, these physicians are more apt to recognize the young patient with chest pain and a normal electrocardiogram as having panic disorder with no need to be hospitalized, explains principal investigator Peter Franks, M.D. Dr. Franks and his colleagues at the University of Rochester School of Medicine used the claims database of a large Rochester managed care organization to correlate diagnosis of depression among adults assigned to a PCP (457 family physicians and internists) with avoidable hospitalizations for a variety of conditions during 1995.

See "Do physicians who diagnose more mental health disorders generate lower health care costs?" by Thomas L. Campbell, M.D., Dr. Franks, Kevin Fiscella, M.D., and others, in the April 2000 Journal of Family Practice 49(4), pp. 305-310.

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