Only about one in five individuals prescribed treatment for depression receive good quality aftercare in primary care, defined as three or more follow-up visits over three months, according to a review of 19 studies. About 30% of patients saw their primary care physician within a month of an antidepressant prescription, and 60% had at least one documented follow-up visit in three months. In mental health care settings, about half of individuals received adequate aftercare. The review found a significant deficit in follow-up care for depression in primary care settings compared to specialist mental health settings.

1. International Congress of the
Royal College of Psychiatrists
21-24 June 2010, EICC, Edinburgh
Quality of Care for Individuals with Depression:
How Many People Receive Adequate Follow-Up Visits?
Niman Gajebasia ST5 in psychiatry, Leicester Partnership Trust, Leicester Bhanu Chadalavada Consultant in general adult psychiatry,
Northampton Mental Healthcare Trust, Northampton Alex J Mitchell Consultant in Psychiatry, Department of Cancer & Molecular Medicine,
University Hospitals Leicester (UK) ajm80@le.ac.uk
AIMS
To review quality of follow-up care provided by healthcare professionals for those with established depression.
BACKGROUND REVIEW
There is concern about the quality of aftercare given to individuals with established depression, particularly in primary care and
hospital settings. Adequate follow-up depression care has been associated with decreased likelihood of 12-month all-cause
mortality (Psychiatr Serv 59:1399-1405, December 2008)
METHODS Systematic search and critical appraisal of evidence from 1980 to June 2010. Quality standards from NICE =
(National Institute for Health and Clinical Excellence) QHSC (Quality and Safety in Health Care) and QIGP (Quality Indicators
for General Practice) suggest patients should be offered a follow-up appointment within 4 weeks of initiating first treatment.
RESULTS We located 19 studies examining follow-up visits and related quality of care. 6 involved aftercare in the community; 2
involved quality of care in specialist or mental health settings and 11 examined aftercare by general practitioners.
In primary care about 30% patients were seen by their physicians within a month of the antidepressant being prescribed and 60%
had at least one documented follow up visit in 3 months. If “good to very good” quality care was defined by 3 or more visits over 3
months then only 10% met this standard. This deficit did not appear to be caused by non-compliance with visits, as of those asked
to make a follow-up appointment 80-90% made the appointment. In comparative studies the proportion offered adequate aftercare
in a 3month period after the index visit/prescription was significantly higher for the psychiatrist group (approximately 50%) than it
was for the primary care group (about 20%) (p<.05). For young people, two studies showed that only 28.1% had the recommended
number of visits and during the first 4 weeks of treatment and only 17.7% had a visit for mental healthcare.
Depression Quality of Care: follow-up visits i community & mixed Depression Quality of Care: follow-up visits ii Primary care
CONCLUSIONS Only about one in five individuals prescribed treatment for depression receive good quality
aftercare in primary care and about half of individuals in mental health care receive this standard. However more
than half receive at least one visit following an antidepressant prescription.