Electronic medical record availability and primary care depression treatment

Abstract

Background: Electronic 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.

Objective: To examine how chronic conditions impact the odds that depressed patients receive depression treatment in primary care practices with EMRs compared to practices without EMRs.

Design: The 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.

Patients: All visits to primary care providers made by patients ages 18 and older with physician-identified depression (N = 3,467).

Main measures: Outcomes include depression treatment which is defined as receipt or ordering of antidepressant medication and/or mental health counseling.

Key results: EMRs 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.

Conclusions: EMRs appear to have an unintended negative association with depression care provided during visits made by primary care patients with multiple chronic conditions.