Methods: This study was completed using 2014-2015 data from the National Ambulatory Medical Care Survey (NAMCS). The sample included 2,865 visits where adults were identified as having depression by a primary care specialist. Visits were categorized in three groups relating to available EHR functionality: having EHR-based prescribing supports present, having prescribing supports and mental health HIE present, or having neither. Depression treatment included physician notation that antidepressants were prescribed and/or psychotherapy or mental health counseling were offered. Using three separate models, logistic regression examined the impact of EHR functionalities on the odds of receiving any depression treatment, antidepressants, or a mental health intervention. Patient level and clinical level covariates were included in the fully adjusted model.
Results: Of the study sample, 59% (N=1,700) received any depression treatment. The vast majority (58%, N=1,673) were prescribed antidepressant medications, while only 2.4% (n=69) were offered a mental health intervention. Compared those without these functions, visits with only prescribing supports present (OR=1.6, p<.05) and visits with both prescribing supports and mental health HIE (OR=3.4, p<.001.) present increased the odds of receiving any type of depression treatment. Similarly, prescribing supports (OR=1.6, p<.05) and combined prescribing supports and mental health HIE (OR=3.6, p<.001) increased the likelihood of antidepressant prescribing. Neither EHR functionality significantly impacted linkages to mental health interventions.
Conclusion: Many patients experiencing depression were not linked to treatment, and were rarely offered mental health interventions. Visits where prescribing supports and mental health HIE were present increased the likelihood of receiving depression treatment. Importantly, the improvement in rates of depression treatment were primarily accounted for by increases in antidepressant prescribing, while EHR functionality did not impact the likelihood of being offered a mental health intervention. This suggests that while particular EHR capacities can increase rates of depression treatment, it also influences the type of depression care patients receive. This underscores the importance of ensuring EHR function and design is well aligned with best practices. Particular implications for interdisciplinary depression treatment will be discussed.