Program zeros in on critical times for noncompliance

Patients are treated by primary care physicians

There are two critical times when patients newly diagnosed with depression are likely to stop taking their medicine — the early weeks of treatment and after three months when they start to feel better, says Laura Schneider, LSCW, CEAP, manager of assistance programs and the Taking Charge of Depression Program for PacifiCare Behavioral Health.

The health plan's care consultants in the depression program call the members during these critical times to encourage them to keep taking their medication, Schneider says.

"During the first couple of weeks, many people stop taking the medication because of the side effects. After about three months, when they're feeling better, they stop taking it, not realizing that they are more prone to a relapse if they stop taking the medicine too early," Schneider says.

PacifiCare Behavioral Health, based in Santa Ana, CA, is a wholly owned subsidiary of PacifiCare Health Systems. It is a managed ­behavioral health organization (BHO) providing mental health, chemical dependency, and employee assistance services to clients that include health plans, union trust funds, employers, school districts, and public sector agencies.

"One of the unique aspects of the program is that it targets patients who are being treated for depression by primary care physicians. Our goals include making sure the patients continue to stay on their medication and supporting the patients and the physicians," Schneider says.

Patients receive three mailings and a minimum of five telephone calls from the health plan's care consultants during the six months they are enrolled in the program. They are encouraged to call their care consultant at any time.

Members are referred by their primary care physician and are contacted by mail and asked to sign a consent form to participate in the program.

The health plan's care consultants call the newly enrolled members and administer the HANDS™ risk assessment for depression. If the HANDS™ score is above a certain number, they transfer the case to a licensed clinician, who does a full assessment and evaluation and handles any emergency situations.

The care consultants repeat the eight-question risk assessment every time they call the members.

"We typically see an improvement in the scores from the beginning to the end of the program," Schneider says.

The BHO sends members materials that include education about depression, the importance of taking their medication regularly, activities that can help depression, such as exercise and dancing, and a booklet for family members.

"Not everything works for every person, so we try to give them information on everything," says Schneider.

The care consultants encourage the members to discuss any issue, including cost of medication and transportation to the drugstore.

"We encourage them to talk to the doctor and to us about anything that may be a barrier to compliance," Schneider says.

For instance, if the member is experiencing unpleasant side effects from the medication, the care consultant can act as a coach in helping him or her decide what to say to the physician.

Members receive a physician visit worksheet with triggers of topics to discuss, such as moods, medication, sleep, and social activities.

"We ask them to write down any questions they have for the doctor and then we walk them through the visit over the telephone," Schneider says.

If the member doesn't feel able to communicate with the physician, the care consultant either calls or faxes the physician and describes the issues before the member's next appointment.

The care consultants help members find community resources that will help with transportation to medical appointments and pharmacies and can help the member locate pharmacies that deliver. They work in the same area as PacifiCare Behavioral Health's employee assistance program team (EAP) team, the people who are most familiar with community resources.

After the final call, PacifiCare Behavioral Health sends out a patient satisfaction questionnaire. There is not a huge rate of return, but the people who do return the questionnaire are positive about the program, Schneider says.

The final mailing describes how to manage a relapse and how to spot symptoms that could signal a relapse.

PacifiCare Behavioral Health started its depression program about three and a half years ago. The original intent basically was to assist any members with depression, whether they had been on medication for 15 years or longer, were newly diagnosed, or called because they were feeling suicidal and needed acute treatment.

"We had a very broad definition of what depression is and what the criteria was. Since it was open-ended, we had a really divergent group of people, which made it hard to measure results," Schneider says.

The behavioral health organization narrowed the criteria and now concentrates on people who are newly diagnosed with depression who have recent prescriptions for medication and are willing to participate in a six-month program.

"We are trying to impact this group and see if we can make a change in the way they feel, how they accept medication, their productivity and functioning within their own family," Schneider says.