May 7, 2014

Patients with depression who typically receive primary care at a physician's office are more engaged in managing their mental health care than those who rely on outpatient clinics or the emergency department, according to a new study led by Dr. Jie Chen in the University of Maryland School of Public Health. Access to primary care is one of several contextual factors identified that can affect patient activation, or the ability and confidence of patients to manage their own health and health care. Higher levels of patient activation predict better treatment compliance and health outcomes, the study authors note.

"Patients with mental disorders are less engaged in their health care than patients with other chronic diseases, so it is important to activate this group," said Dr. Chen, assistant professor in the department of Health Services Administration. "In communities where patient activation is low, such as low-income communities with a large population of foreign-born individuals, there is an even greater need for interventions at mental health care institutions to engage residents in their health."

The study, published in the journal Health Education & Behavior, analyzed data from a large nationally representative survey that included measures of patient activation. Researchers assessed patient activation among patients diagnosed with depression in relation to contextual variables such as site of usual source of care, community characteristics, and other demographic characteristics. Higher levels of patient activation were associated with using a physician's office instead of an outpatient clinic or emergency department as one's usual source of care. At the county level, more community mental health institutions, lower percentages of foreign-born populations, and higher per capita income were also associated with higher activation scores.

The authors stress that patient activation is a "blockbuster drug" with the potential to reduce health care cost, improve patient health and increase the efficiency of the health care system. They offer several implications for policy, including improving patient activation at outpatient clinics and emergency departments and having physicians assess symptoms of depression even when it is not the primary diagnosis. Tailored policies targeting underserved communities could be cost effective to engage residents in their own health, improve long-term well-being and reduce health disparities.

View the paper online at http://heb.sagepub.com/content/early/2014/04/29/1090198114531781.abstract

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