Behavioral Health
Antidepressant Medication Management
In any given one year period, 5.8% of the population or about 15 million American adults suffer from major depressive illness. If not properly treated with counseling and medications, patients can sometimes experience serious complications. Approximately 70% of patients who are diagnosed with severe depression respond favorably to antidepressant medications.
This measure is reported in two-parts that look at different facets of successful pharmacological management of depression. The two components of the measure estimate:
- Effective Acute Phase: The percentage of eligible members who remained on antidepressant medication continuously for 12 weeks after the initial diagnosis;
- Effective Continuation Phase: The percentage of eligible members who remained on antidepressant medication for at least six months after the initial diagnosis.
Nationally, only about half of all patients treated with antidepressant medications receive care for the recommended period of time. Better treatment rates suggest fewer patients are likely to experience a relapse of their depression symptoms. Health plans can improve clinical outcomes for their members by working in partnership with physicians to encourage appropriate treatment and improved medication management for patients with new episodes of depression.
Follow-up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder
ADHD is considered one of the most prevalent chronic conditions in childhood. Children with ADHD may experience significant functional problems, such as school difficulties, academic underachievement, troublesome relationships with family members and peers and behavioral problems. Given the high prevalence of ADHD among school-aged children (4 percent to 12 percent), primary care clinicians will encounter children with ADHD in their practices regularly and should have a strategy for diagnosing and long-term management of this condition. Pharmacologic treatment is one of the most widely studied treatments for ADHD.
The American Academy of Pediatrics (AAP) guidelines recommend that once a child is stable, an office visit every three to six months allows assessment of learning and behavior. Follow-up appointments should be made at least monthly until the child’s symptoms have been stabilized.
This measure is reported in two parts:
- Initiation phase which is used to assess the percentage of health plan members 6 to 12 years of age with an ambulatory prescription dispensed for attention-deficit/hyperactivity disorder (ADHD) medication who had one follow-up visit with a practitioner with prescriptive authority during a 30-day initiation period.
- Continuation and maintenance phase which reports the percentage of members 6 to 12 years of age with an ambulatory prescription dispensed for ADHD medication who remained on the medication for at least 210 days and who, in addition to the visit in the initiation phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the initiation phase ended.
Follow-up After Hospitalization for Mental Illness
Mental illnesses such as depression, schizophrenia, and anxiety are real health conditions that, if untreated, can be as disabling and serious as cancer and heart disease. Fortunately, advances in mental health research and the availability of newer, more effective medication have broadened the treatment options for mental health problems and improved the overall level of mental health care.
Hospitalization is sometimes the most appropriate treatment for serious mental illness. When patients are discharged from the hospital, ongoing medical care and emotional support is essential to continued recovery. Patients who receive regular follow-up therapy with a mental health provider usually experience a smoother transition back to their regular routines at home and work. They also have lower rates of relapse and re-hospitalization.
This HEDIS indicator measures the percentage of health plan members ages 6 years and older who were seen on an outpatient basis by a mental health provider within seven days and within 30 days after being discharged for an inpatient mental health stay. Health plans can encourage appropriate follow-up treatment by educating members and physicians regarding the benefits of continued therapy and support in the immediate post-hospitalization period and about the various treatment options available to them.
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