Second-generation antidepressant use in treatment for major depressive disorder: an examination of guideline components and healthcare utilization Public Deposited

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  • March 21, 2019
Creator
  • Chen, Shih-Yin
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy
Abstract
  • Major depressive disorder (MDD) is a prevalent mental health illness and antidepressant therapy is the most frequently provided treatment option. Clinical guidelines have been developed for depression management. Guidelines recommend that depressed patients receive frequent follow-up visits and complete an acute phase regimen lasting a minimum of 6-8 weeks to remove symptoms, followed by a continuation phase for 4-9 months to prevent relapse. The objectives of this dissertation are to examine whether there are differences between patients initially prescribed an antidepressant by providers with different specialties, to understand what factors are associated with receipt of guideline-concordant care, and investigate how subsequent healthcare utilization varies by provider specialty and guideline concordance. Claims data from a large national plan in 2000-2004 were used to identify individuals who initiated antidepressant treatment for MDD. Guideline-concordant follow-up visits were identified based on service claims, and completion of acute phase and continuation phase antidepressant regimens was evaluated based on prescription refill records. All-cause and mental health-related hospitalizations and emergency room visits were examined during a one-ear period after treatment completion. Logistic regressions were conducted to assess the association of the outcomes with initial prescriber specialty and other factors. We found that several pre-disposing, enabling and need variables differ among patients with different types of providers. After adjustment, patients initially prescribed an antidepressant by psychiatrists were more likely to receive guideline-concordant follow-up visits, and no provider differences were found for antidepressant treatment completion. Patients who received guideline-concordant follow-up visits were more likely to complete antidepressant treatment. Completion of acute phase treatment was negatively associated with all-cause hospitalization during the one-year period afterwards. These results showed that routine care for antidepressant management falls short of guideline recommendations. These findings underscore the need for quality improvement particular in primary care. Strategies to promote frequent follow-up should be encouraged given the positive association with antidepressant adherence. This study also helps identify the modifiable factors to target for intervention and provides evidence to justify resource allocation to promote quality of care among patients with MDD.
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  • Maciejewski, Matthew
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