Inequities in Medical Follow-Up for Depression: A Population-Based Study in Montreal

Objectives: The aim of this study was to measure the quality of medical follow- up of depression in a universal-access health care system and identify its main correlates. Methods: This retrospective cohort study of adult patients who received diagnoses of depression between April 2003 and March 2005 in Montreal used administrative data to measure the quality of medical follow-up within the first three months of diagnosis. Indicators of adequate follow-up care included having at least one outpatient visit to a family physician or a psychiatrist, the first follow-up visit within 30 days of diagnosis, more than half of follow-up visits with the same physician, and at least three follow-up visits. Results: During the study period, 41,375 Montrealers aged 18 and older received a new diagnosis of depression. Among those, 90% (N=37,071) had at least one visit with a physician (family practitioner or psychiatrist) within the first three months of diagnosis, 59% (N=24,295) benefited from continuity with their usual provider, 50% (N=20,846) received a prompt follow-up visit, and 48% (N=19,819) had optimal contacts with practitioners. Medical follow-up was less adequate for older patients, male patients, patients living in very deprived neighborhoods, and patients with high morbidity levels. The quality of medical follow- up was better when both a family physician and a psychiatrist were involved. Conclusions: The results suggest that universal access facilitates optimal practitioner contacts during the acute treatment phase of depression. However, despite universal access, the findings revealed that some inequities persist. (Psychiatric Services 61: 258-263, 2010)