Research Thrives, Drives Many APA Activities

Implementation of the Medicare Part D prescription drug benefit on January 1 raised concerns about the transition of an estimated 6 million to 7 million Medicare and Medicaid “dual-eligible” beneficiaries who have mental and addictive disorders, as they move from Medicaid to the new Medicare prescription drug plans. In a national study, APIRE staff researchers are monitoring dual-eligible psychiatric patients' access to medications and disruptions in continuity that may lead to adverse clinical consequences. Preliminary findings from the first three months of data collection show that nearly half of all the patients studied have had at least one problem with medication access or continuity, and more than one-quarter of those patients experienced a serious adverse clinical consequence.

The APIRE PRN, American Academy of Family Physicians, and American College of Physicians recently completed the pilot phase of the National Depression Management Leadership Initiative. This collaboration aims to assess the clinical utility of a simple metric—the nine-item Patient Health Questionnaire (PHQ-9)—to measure the severity of depression and test office systems and management strategies to optimize depression monitoring in routine clinical practice. A total of 16 primary care and 17 psychiatric practices concluded data-collection activities for this project in April. Records kept by the psychiatrists revealed that PHQ-9 scores influenced the clinical decisions they made for 92 percent of their patients, leading to a change in treatment for 37 percent of these patients. An expanded national study is being developed.

APIRE and PRN staff continue their involvement in a long-running study the effect of parity on the use and cost of mental health care under the Federal Employees Health Benefits program. Results will have important implications for future parity legislation and will serve as a model for other insurance plans.