Electronic Medical Record Availability and Primary Care Depression Treatment

ABSTRACTBackgroundElectronic medical records (EMR) are commonly believed to improve quality of care. Primary care patients with multiple chronic conditions have potentially greater opportunity to benefit from receiving care at practices with EMRs if these systems help coordinate complex care.ObjectiveTo examine how chronic conditions impact the odds that depressed patients receive depression treatment in primary care practices with EMRs compared to practices without EMRs.DesignThe study uses logistic regression to analyze cross-sectional data of primary care physician office visits in freestanding, office-based practices from the 2006–2008 National Ambulatory Medical Care Surveys.PatientsAll visits to primary care providers made by patients ages 18 and older with physician-identified depression (N = 3,467).Main MeasuresOutcomes include depression treatment which is defined as receipt or ordering of antidepressant medication and/or mental health counseling.Key ResultsEMRs were associated with significantly lowered odds that depressed patients received depression treatment (OR = 0.75, p = 0.009, 95% CI: 0.61-0.93); however when stratified by the number of chronic conditions, this association was observed only in patients with three or more chronic conditions (OR = 0.50, p > 0.001, 95% CI: 0.36-0.70). EMRs did not have a significant association with depression treatment for patients with two or fewer chronic conditions.ConclusionsEMRs appear to have an unintended negative association with depression care provided during visits made by primary care patients with multiple chronic conditions.

[1]  R. Kessler,et al.  Changing profiles of service sectors used for mental health care in the United States. , 2006, The American journal of psychiatry.

[2]  J. Feldman,et al.  Sample design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. , 1988, Vital and health statistics. Series 2, Data evaluation and methods research.

[3]  Gregory Makoul,et al.  The Use of Electronic Medical Records , 2001 .

[4]  Jennifer Lai,et al.  Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis , 2007 .

[5]  Jie Huang,et al.  Research Paper: Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication during Outpatient Primary Care Visits , 2005, J. Am. Medical Informatics Assoc..

[6]  D. Bates,et al.  Electronic health record use and the quality of ambulatory care in the United States. , 2007, Archives of internal medicine.

[7]  D. Roter,et al.  Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. , 2006, Patient education and counseling.

[8]  Gregory Makoul,et al.  Research Paper: The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters , 2001, J. Am. Medical Informatics Assoc..

[9]  Peggy Nygren,et al.  Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis , 2006, The Annals of Family Medicine.

[10]  D. Satcher.  Mental Health: A Report of the Surgen General , 1999 .

[11]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[12]  D. Cherry,et al.  National Ambulatory Medical Care Survey: 2005 summary. , 2007, Advance data.

[13]  Olga V. Demler,et al.  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). , 2003, JAMA.

[14]  R. Stafford,et al.  Electronic health records and clinical decision support systems: impact on national ambulatory care quality. , 2011, Archives of internal medicine.

[15]  Marc Berg,et al.  System-related Errors Nature of Patient Care Information Information Technology in Health Care: The Some Unintended Consequences of , 2010 .

[16]  Sowmya R. Rao,et al.  Electronic health records in ambulatory care--a national survey of physicians. , 2008, The New England journal of medicine.

[17]  D. Coplen.  Types of Unintended Consequences Related to Computerized Provider Order Entry , 2007 .

[18]  Harold Alan Pincus,et al.  National trends in the outpatient treatment of depression. , 2002, JAMA.

[19]  Nick Booth,et al.  Identification of high-quality consultation practice in primary care: the effects of computer use on doctor-patient rapport. , 2004, Informatics in primary care.

[20]  D A Zarin,et al.  Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. , 1998, JAMA.

[21]  R. Kessler,et al.  Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[22]  James D. Carpenter,et al.  Categorizing the unintended sociotechnical consequences of computerized provider order entry , 2007, Int. J. Medical Informatics.

[23]  M. Olfson,et al.  National trends in the treatment for depression from 1998 to 2007. , 2010, Archives of general psychiatry.

[24]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.

[25]  E. Mercier-Guidez.  Psychiatric patients and water intoxication: implications for diagnosis and treatment , 1998, Intensive Care Medicine.

[26]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005 .

[27]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[28]  Richard J. Holden,et al.  Cognitive performance-altering effects of electronic medical records: an application of the human factors paradigm for patient safety , 2011, Cognition, Technology & Work.

[29]  R. Kessler,et al.  Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network. , 1999, Archives of general psychiatry.

[30]  Patricia Dolan Mullen,et al.  Cross-Sectional Comparison of Electronic and Paper Medical Records on Medication Counseling in Primary Care Clinics: A Southern Primary-care Urban Research Network (SPUR-Net) Study , 2007, The Journal of the American Board of Family Medicine.

[31]  Rebecca Steinbach,et al.  Communicating about medications during primary care outpatient visits: the role of electronic medical records. , 2005, Informatics in primary care.

[32]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[33]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.