Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH		Volume 27 (Supplement 1) Volume 27, Supplement 1, Fall 2007 J Contin Educ Health Prof 2007; 27(Suppl1):S26 RESEARCH ARTICLE Disparities in depression care in managed care settings Chandra Kee, Karen M. Overstreet A b s t r a c t The implementation of managed health care two decades ago produced sweeping changes in the delivery of health care. A large number of patients who have depression are cared for in managed care settings. Despite the fact that managed health care programs have offered the advantage of affordable and effective treatment of depression to many patients, racial and ethnic minorities remain underdiagnosed and undertreated. Diagnosis of depression, prescribing of antidepressant therapy, and referral for psychotherapy occur significantly less often in minority patients compared with whites. In the managed care setting, a number of issues at the physician level may negatively affect the quality of depression care, including attitudes toward psychiatry and mental health services, unfamiliarity with best practice guidelines for depression, and lack of cultural competency. On the other hand, a number of innovative approaches (eg, collaborative care) have demonstrated effectiveness in managed care settings. In some cases, physician education can be integrated with these approaches to assist health care providers in managed care organizations to provide the best possible depression care. This article focuses on issues relevant to depression care of minorities in the managed care sector, cites strategies for improving quality of depression care, and discusses implications for CME. Lessons for Practice Approximately 20% of the US population is enrolled in a health maintenance organization (HMO) and the number is much higher if other types of managed care plans are included; many of these members have depression and/or common illnesses that are associated with depression (eg, cancer, diabetes, heart disease). Racial and ethnic minorities enrolled in public or private managed care plans appear to experience disparities in care similar to those of patients in non-managed-care plans. Because many minority patients who have depression are seen in managed health care settings, CME programs that focus on screening for and treating depression in minorities should be designed for physicians in these settings. CME interventions that enhance cultural competence among managed care physicians will facilitate earlier recognition of depressive illness in minority patients and reduce disparities in depression care.
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