Electronic health records may focus a doctor's attention on certain medical conditions, leading to undertreatment for depression, researchers suggest.
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Patients with three or more chronic conditions are half as likely to receive treatment for their depression during a visit to a doctor's office that uses electronic health records (EHRs) when compared with patients who visited paper-based practices. At least that's the conclusion of an investigation recently published in the Journal of General Internal Medicine.
The study, conducted by researchers at the University of Florida and the University of South Florida, analyzed the odds of receiving treatment for depression during a doctor's visit by examining data from the National Ambulatory Medical Care Surveys (NAMCS) of 3,467 physician office visits by patients from 2006 to 2008. Researchers focused on visits to primary care providers by patients ages 18 and older with physician-identified depression. The 3,467 visits were divided into two groups: 2,584 visits to practices without EHRs, and 883 visits to practices with EHRs.
The EHRs showed that patients were receiving either mental health counseling or one or more antidepressants, such as amitriptyline, amoxapine, and bupropion. The study revealed that 1,092 patients had one chronic condition, 916 had two, and 1,459 had three or more chronic conditions, including arthritis, asthma, cancer, and congestive heart failure.
The report found that for patients with three or more chronic conditions, EHRs "appear to have an unintended negative association with depression care provided during visits made by primary care patients with multiple chronic conditions."
On the other hand, researchers also found that patients with depression combined with two or fewer chronic conditions who visited a physician with an EHR had the same probability of being treated for depression as those patients whose physician practice operated without an EHR.
Dr. Jeffrey Harman and his colleagues can't explain why patients who have three or more chronic conditions and visited a physician using an EHR were significantly less likely to be treated for their depression, but in an interview with InformationWeek Healthcare, he said that the study does offer a warning for EHR-enabled physicians.
"The study suggests two things ... when physicians are working with an EHR they may end up being engaged with the computer instead of the patient," Harman said. "Second, EHRs are often designed to focus physicians' attention on biomedical conditions, and the more medical conditions that exist, the greater the attention is toward addressing, for example, diabetes, high blood pressure, or congestive heart failure" rather than depression.
According to Harman, whatever the underlying cause, EHR vendors need to address how they design these systems in the future.
"EHRs are tools meant to assist physicians in the delivery of care and to improve patient outcomes," Harman said. "Primary care physicians only have about 15 minutes per patient. Therefore vendors need to think about workflow--how the physician works with these computers, and how to make EHRs easier to access and enter information related to mental illness and other chronic conditions."
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