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Using an electronic medical record for diagnostic and treatment feedback does not lead to better primary care for depression

Use of an electronic medical record (EMR) system to inform primary care physicians (PCPs) of a patient's depression diagnosis and provide them with treatment recommendations does not improve depression care or patient outcomes 6 months later, according to a recent study supported by the Agency for Healthcare Research and Quality (HS09421). These findings are similar to others which suggest that EMR systems are more effective at triggering one-time events—such as ordering a mammogram or flu vaccine—than for ongoing management of a chronic medical condition, explains Bruce L. Rollman, M.D., M.P.H., of the University of Pittsburgh School of Medicine.

Dr. Rollman and colleagues randomly assigned PCPs at an academically affiliated primary care practice to active care, passive care, or usual care for 200 patients who screened positive for major depression. PCPs were notified of a patient's depression diagnosis via an interactive E-mail alert (flag) generated through the EMR system and an electronic letter signed by study investigators. The patient then was scheduled for a followup office visit with the PCP to discuss the depression diagnosis.

The EMR system then exposed PCPs in the active care group to patient-specific, guideline-based advice for treating depression over the ensuing 6-month period in keeping with the patient's clinical status as recorded by the PCP in his or her clinical notes. Clinicians in the usual care group received no additional patient-specific treatment advice or reminders of care over the course of followup. PCPs in the passive care group were reminded of each patient's depression diagnosis on the paper encounter form generated for each patient visit, which encouraged them to treat the depressive episode but offered no details on how to do so.

Active-care PCPs received one or more patient-specific advisory messages on the paper encounter form that were based on AHRQ's depression practice guideline and modified for electronic dissemination via the EMR system. The message content varied depending on the PCP's earlier actions as entered into the EMR system and usually prompted the PCP to mouse-click for more advice. Patients' mean depression scores decreased from the initial visit to 3- and 6-month followup regardless of their PCP's group. Also, there were no differences in measures of recovery at 6 months or in depression process of care measures (for example, prescribing of antidepressants or referral to mental health specialists) among the three PCP groups.

See "A randomized trial using computerized decision support to improve treatment of major depression in primary care," by Dr. Rollman, Barbara H. Hanusa, Ph.D., Henry J. Lowe, M.D., and others, in the July 2002 Journal of General Internal Medicine 17, pp. 493-503.

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