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June 21, 1995

Cost-effective Treatment of Depression-Reply

JAMA. 1995;273(23):1834. doi:10.1001/jama.1995.03520470041022

In Reply.  —Can quality improvement interventions raise the value of care for depression in 1995? Dr Solomon suggests that much of the quality improvement needed to increase the value of care has already occurred because recent studies and the publicity surrounding newer antidepressant medications have raised physician awareness of depression.We doubt that quality of care has improved so much since the late 1980s that it invalidates our studies because treatment rates were extremely low. For example, only one fifth of the most seriously depressed patients in general medical practices received appropriate antidepressant medications. Even a doubling of this rate remains substantially below the level we modeled for quality improvement. Such a doubling is unlikely to have occurred because it would require that almost all detected cases receive appropriate antidepressant medication.In the MOS, we identified excess use of minor tranquilizers as one source of inefficient care. Some clinicians have

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