Frequently Asked Questions

The Polaris-Medical system is grounded in an extensive body of research by Polaris and independent scientists. The following is a brief summary of research findings related to frequently asked questions.

1. Why should primary care physicians screen for depression and anxiety?

Depression is prevalent among primary care patients. Thirty percent (30%) have significant depressive symptoms; ten percent (10%) meet criteria for major depression (Department of Health and Human Services, 1993). When anxiety is included prevalence is even higher. More than one out of three patients experience clinically significant symptoms of depression or anxiety; i.e. symptoms that interfere with their quality of life and daily functioning (Kessler, 1999).

In the absence of a standardized screening procedure, physicians usually fail to detect clinically significant depression and anxiety. Physicians fail to detect depression in as many as two out of three patients with clinically significant symptoms (Rost et al., 1998). They tend to misinterpret serious mental health symptomology as simple worrying that does not warrant diagnosis and treatment (Lecrubier & Hergueta, 1998).

Untreated depression/anxiety is associated with significantly higher risk for adverse outcomes of treatment for chronic medical conditions. Untreated depression and anxiety affect physical health; significant relationships have been found between untreated depression and anxiety and ulcer disease, angina, thyroid disease, diabetes, heart disease and other chronic medical conditions (Wu et al., 2003, Ornish, 2001). Chronic, untreated mental illness also complicates the treatment of medical conditions by reducing compliance with medication and other medical therapy recommendations (Blumenthal et al., 1982).

Patients with untreated mental health disorders are high utilizers. In most cases, a practice’s “fat file” patients are those suffering from depression, anxiety and/or somatization disorder. These patients often present with medical complaints including stomach pains and trembling (indicative of anxiety) or complaints of difficulty swallowing or dizzy spells (indicative of depression; Post et al., 1998). They can be expensive and frustrating to treat: despite multiple office visits and lab tests, their medical complaints often persist if their mental health condition is untreated.

Success rates for treatment of depression and anxiety are high. Research indicates that 60% to 80% of patients that undergo psychotherapy or pharmacological treatments show clinically reliable improvement. These patients experience an improved quality of life and potentially, reduced risk for medical illness.

Patients appreciate their physicians’ addressing depression and anxiety. They understand that treatment that takes both physical and emotional distress into account indicates concern for them as individuals.

Screening and treatment for depression/anxiety can generate significant revenue. Screening for mental health conditions in patients with a primary medical diagnosis, and up to four reassessments per year, is reimbursable under recent Medicare guidelines, and via uPolaris-Medicalodes of E&M billings for some commercial insurers.

It is good medicine – as in best practices. Both the World Health Organization and the United States Preventive Services Task Force recommend that all adult primary care patients be screened for depression.

2. Why isn’t everyone doing it?

There are several reasons. Primary care physicians and office staff are severely pressed for time dealing with patient interactions and administrative tasks. Traditional screening methods (including the method recommended by the USPSTF) produce many false positives. Primary care physicians receive little or no training in the treatment of mental disorders. Due to the stigma associated with mental health conditions, physicians may feel that their patients would be offended if asked about their psychological problems. Lack of training and anticipated patient resistance may make the physician uncomfortable inquiring about the patient’s emotional condition. In cases where the physician is under a great deal of stress, discussion of depression or anxiety may hit too close to home. Screening alone has rarely resulted in improved healthcare outcomes.

Some of these concerns are misguided. For example, research shows that patients usually welcome their physicians’ attention to their emotional concerns (CITATION). But the issues are largely valid, and suggest the features required for an effective depression/anxiety screening and management system:

1) It should not require a lot of time of office staff, and no physician time beyond review of a “lab report.”

2) It must be easily integrated into routine office procedures.

3) It must accurately reflect symptom severity, with minimal false positives.

4) Screening results must be clinically actionable, indicating whether intervention is advisable and, if so, the action that should be taken.

Key Features

The importance of Polaris-Medical product features is best illustrated through comparison with other measures for depression screening and management. The most critical difference relates to the utility of Polaris-Medical for clinical decision support. Like many other scales, Polaris-Medical provides a reliable and valid assessment of the severity of patient-reported symptoms of depression and anxiety. However, the Polaris-Medical system goes well beyond this. It provides additional information to help the physician (1) decide whether treatment should be recommended; (2) determine which type of treatment (e.g., psychotherapy, medication) should be considered; (3) motivate the patient to accept the recommendation; and (4) monitor the patient’s progress to determine whether treatment is working. Finally, Polaris-Medical is designed to accomplish these things with (5) minimal staff effort and (6) no demands upon the physician beyond reviewing the computer-generated report.

The benefits of Polaris-Medical in relation to traditional measures of depression are illustrated through comparison to the PHQ-9. The PHQ-9 has been commonly been used for research on the prevalence and consequences of depression in Polaris-Medical patients. Polaris-Medical is well suited to research applications, but is designed for clinical use. Other key differences are:

1) Polaris-Medical reports fewer “false positives.”

2) Polaris-Medical is fully automated.

3) Polaris-Medical produces real time, clinically actionable “lab” reports.

4) Polaris-Medical provides a direct measure of the severity of DSM IV depressive symptoms.

5) Anxiety is very frequently co-morbid with depression. Polaris-Medical provides a direct measure of the
severity of DSM anxiety symptoms. This is important to clinical decision-making, since some medications are effective for both depression and anxiety.

6) Polaris-Medical provides for the monitoring of the patient’s condition over time.

7) Polaris-Medical alerts the physician to conditions that effect intervention decisions (e.g., bereavement, bipolar disorder, chemical dependency, suicidality).

8) Polaris-Medical is normed to both primary care and mental health populations, indicating the severity of depression and anxiety symptoms in relation to patients in MH treatment. This feature contributes to the clinical utility of Polaris-Medical. A patient whose score is elevated in relation to primary care norms might be provided with self-help information about depression and/or anxiety, and monitored (“watch and wait”). A patient whose score is in the range typically found in mental health treatment might be encouraged to accept a referral for a more thorough psychological assessment, or a medication trial.

9) Polaris-Medical provides treatment history information important to treatment planning: whether the patient is taking psychoactive medications; whether there are problematic side effects; whether the patient has ever been in psychotherapy; whether the medications or therapy were perceived to be helpful.

10) It is possible to customize the Polaris-Medical questionnaire (e.g., adding the PHQ-9 or other items, if desired).

11) Polaris-Medical is designed as a “learning system”; see below.

12) Polaris-Medical automatically generates an invoice for reimbursement by Medicare or commercial payers.

Subsequent versions of the Polaris-Medical will provide for severity adjusted projections of Expected Treatment Response (ETR). This will enable healthcare systems to improve the cost effectiveness of their services, and physicians to better motivate their patients. The ETR will, for example, indicate the likely consequences of watchful waiting, medication, psychotherapy, or a combination. It will allow monitoring of actual vs. expected progress.