The American journal of managed care
-
Major depressive disorder: psychosocial impairment and key considerations in functional improvement.
Patients with major depressive disorder (MDD) can experience persistent and substantial functional impairment, and the extent of psychosocial impairment often varies with symptom severity. Factors that may contribute to restoration of psychosocial functioning include the patient's lifetime functional trajectory, the overall effectiveness of depression therapy, and the duration and quality of remission. ⋯ The more effective the therapeutic approach employed to resolve symptoms of depression (eg, long-term duration of treatment, monitoring of patient adherence to treatment, maintenance of asymptomatic remission), the more likely it is that patients with MDD will experience a full restoration of premorbid psychosocial functioning. The goals of this article are to discuss the potential origins of psychosocial impairment, provide literature-based evidence that achieving asymptomatic remission (ie, remission without residual symptoms) is crucial so that functional improvement continues beyond acute-phase treatment, and emphasize the need for an expanded assessment of the illness that fundamentally includes an evaluation of psychosocial functioning, since the restoration of psychosocial functioning does not always accompany the resolution of symptoms in MDD.
-
To assess the feasibility of using medical and prescription drug claims data to develop models that identify patients at risk for prescription opioid abuse or misuse. ⋯ Using drug and medical claims data, it is feasible to develop models that could assist prescription-monitoring programs, payers, and healthcare providers in evaluating patient characteristics associated with elevated risk for prescription opioid abuse.
-
Depression is one of the most common chronic health problems in the United States, and primary care providers manage a substantial proportion of these patients. Unfortunately, most current knowledge about treatment effectiveness is limited to the acute phase of treatment for new depressive episodes, although most patients seen in the primary care setting have chronic depressive symptoms, meet criteria for more than one mental health disorder, and have one or more chronic medical conditions. This article examines the shortcomings of our current approach to assessing treatment effectiveness in primary care, despite the availability of good measures of symptom-based recovery, such as the 9-item Patient Health Questionnaire (PHQ-9). ⋯ Although there is not yet a standard measure to assess emotional recovery, well-being, or functional recovery, brief measures such as the Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, World Health Organization 5-Item Well-Being Index, and new Remission Evaluation and Mood Inventory Tool are available. The opportunity now exists to use these simple tools to integrate outcome monitoring into routine care in the same way other chronic health problems, such as asthma or diabetes, are monitored. Options such as point-of-care outcome assessment with PHQ-9, plus a functional recovery tool; clinician extender ("care manager") monitoring of depressed patients; or a hybrid approach combining both approaches can be practical and effective.