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Madrigal J, Tie EK, Verma A, Benharash P, Rapkin DA, St John MA. The Increasing Burden of Depression in Patients Undergoing Head and Neck Cancer Operations. Laryngoscope 2023; 133:3396-3402. [PMID: 37161918 DOI: 10.1002/lary.30735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Depression remains prevalent in patients undergoing head and neck cancer (HNCA) operations. The present study aimed to assess the impact of depression on perioperative and readmission outcomes following HNCA resection. METHODS All elective hospitalizations involving HNCA resection were identified from the 2010-2019 Nationwide Readmissions Database. Patients were stratified by history of depression. To perform risk-adjustment in assessing perioperative and readmission outcomes, 3:1 nearest neighbor matching was performed. A subpopulation analysis was also conducted to assess interval development of depression in the postoperative period. RESULTS Of an estimated 133,018 patients undergoing HNCA operations, 8.9% (n = 11,855) had comorbid depression. Over the decade-long study period, the prevalence of depression in this population increased (7.8% in 2010 vs. 10.0% in 2019, NPTrend<0.001). Among 24,938 propensity matched patients, those with depression had similar incidence of in-hospital mortality (0.4 vs. 0.7%, p = 0.14) as well as perioperative medical (22.0 vs. 21.9%, p = 0.93) and surgical (10.2 vs. 10.3, p = 0.84) complications, though had higher rates of non-home discharge (16.9 vs. 13.5%, p < 0.001) and 30-day readmission (13.6 vs. 11.8%, p = 0.030). Predictors of depression in the postoperative period included primary coverage by Medicare or Medicaid as well as comorbid anxiety or drug use disorder. CONCLUSION The prevalence of depression in HNCA patients continues to increase. Although depression was not associated with increased in-hospital mortality and complications, it did impact rates of rehospitalization as well as non-routine discharge. Screening and therapeutic interventions addressing such postoperative events may serve to improve long-term clinical and financial outcomes in this at-risk population. LEVEL OF EVIDENCE 3-Retrospective cohort study Laryngoscope, 133:3396-3402, 2023.
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Affiliation(s)
- Josef Madrigal
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Edward K Tie
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, California, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David A Rapkin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Benatar S, Cross-Barnet C, Johnston E, Hill I. Prenatal Depression: Assessment and Outcomes among Medicaid Participants. J Behav Health Serv Res 2021; 47:409-423. [PMID: 32100226 DOI: 10.1007/s11414-020-09689-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study used bivariate and regression-adjusted analyses of participant-level survey and medical data to investigate prevalence of depression among pregnant Medicaid participants, correlates of depression, and the relationship between depression and pregnancy outcomes. The sample included Medicaid participants with a single gestation and valid depression data who were enrolled in Strong Start for Mothers and Newborns 2, a national preterm birth prevention program, from 2013 to 2017 (N = 37,287; 85% of total enrollment). Depression rates in Strong Start were high (27.5%). Depression was associated with being black; having other children, an unplanned pregnancy, or challenges accessing prenatal care; not having a co-resident spouse or partner; and experiencing intimate partner violence. After these and other risk factors were controlled for, depression remained associated with higher rates of preterm birth. Systematic screening and holistic approaches to prenatal care that address depression and associated risks could help reduce rates of preterm birth and other poor pregnancy outcomes.
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Affiliation(s)
| | | | | | - Ian Hill
- Urban Institute, Washington, DC, USA
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3
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McGregor B, Li C, Baltrus P, Douglas M, Hopkins J, Wrenn G, Holden K, Respress E, Gaglioti A. Racial and Ethnic Disparities in Treatment and Treatment Type for Depression in a National Sample of Medicaid Recipients. Psychiatr Serv 2020; 71:663-669. [PMID: 32237981 PMCID: PMC8842821 DOI: 10.1176/appi.ps.201900407] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this secondary data analysis was to describe racial-ethnic disparities in receipt of depression treatment and treatment modality among adult Medicaid beneficiaries with depression from a nationally representative sample-28 states and the District of Columbia-of Medicaid beneficiaries (N=599,421). METHODS Medicaid claims data were extracted from the full 2008-2009 Medicaid Analytic Extract file. The primary outcome was type of depression treatment: medication only, therapy only, medication and therapy, and no treatment. The secondary outcome was treatment for depression (yes-no). Crude and adjusted odds ratios (AORs) were generated for univariate and multivariate models, respectively, and 95% confidence intervals of odds ratios and p values were calculated. RESULTS There were 599,421 individuals in the sample. Rates of depression treatment were lower for African Americans and Hispanics, compared with Caucasians. Percentages receiving no treatment were 19.9% of African Americans, 15.2% of Hispanics, and 11.9% of Caucasians. After full adjustment, African Americans were about half as likely as Caucasians to receive treatment (AOR=0.52), Hispanics were about a third as likely (AOR=0.71), and those from other racial-ethnic groups were about a fifth as likely (AOR=0.84). Caucasians were more likely than any other group to receive medication only. CONCLUSIONS This study contributes to evidence about the intersection of social factors and health outcomes and discusses health care engagement, stigma, and policy drivers of racial-ethnic disparities. The study is the first to identify disparities in rates and types of depression treatment among racial-ethnic subgroups of Medicaid beneficiaries in a nationally representative sample.
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Affiliation(s)
- Brian McGregor
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Chaohua Li
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Peter Baltrus
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Megan Douglas
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Jammie Hopkins
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Glenda Wrenn
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Kisha Holden
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Ebony Respress
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
| | - Anne Gaglioti
- Department of Psychiatry and Behavioral Sciences (McGregor, Wrenn, Holden), Satcher Health Leadership Institute (McGregor, Douglas, Respress), National Center for Primary Care (Li, Baltrus, Douglas, Gaglioti), Department of Community Health and Preventive Medicine (Baltrus, Douglas, Hopkins), and Department of Family Medicine (Gaglioti), Morehouse School of Medicine, Atlanta
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Yucel A, Sanyal S, Essien EJ, Mgbere O, Aparasu R, Bhatara VS, Alonzo JP, Chen H. Racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders. Child Adolesc Ment Health 2020; 25:28-35. [PMID: 32285643 DOI: 10.1111/camh.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders (MDD). METHODS A retrospective cohort study was conducted using the 2005-2007 Medicaid claims data from Texas. Youth aged 10-20 during the study period were identified if they had two consecutive MDD diagnoses and received either medications for MDD or psychotherapy. Patients who received ≥84 days of medications and/or ≥4 sessions of psychotherapy for MDD treatment during 4 months of follow-up were considered meeting the minimum adequacy of treatment. RESULTS The generalized linear multilevel model (MLM) analysis revealed that both Hispanics and Blacks were approximately 30% less likely to receive adequate treatment (Hispanics - OR: 0.67; 95% CI: 0.6-0.8) (Blacks - OR: 0.66; 95% CI: 0.6-0.8) and Hispanic children were 50% more likely to undergo MH-related hospitalization (OR: 1.53; 95% CI: 1.1-2.2) compared to their White counterparts. The odds of meeting the minimum MDD treatment adequacy were comparable between pediatric MDD cases first identified by primary care providers (PCP-I) and psychiatrists (PSY-I) (PCP-I vs. PSY-I: OR: 0.97; 95% CI: 0.8-1.2), and slightly lower in those first identified by social workers/psychologists (SWP-I) as compared to PSY-I (SWP-I vs. PSY-I: OR: 0.81; 95% CI: 0.7-0.9). In all models, the interaction between race/ethnicity and type of provider who initiated MDD care was not statistically significant. CONCLUSIONS Minority youths received less adequate MDD treatment compared to Whites. Hispanic children had the highest risk of having mental health-related hospitalization. The specialty of provider who initiated MDD care had limited impact on treatment quality and was not associated with the racial/ethnic variations in treatment completion and mental health-related hospitalizations.
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Affiliation(s)
- Aylin Yucel
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Swarnava Sanyal
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Ekere J Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Osaro Mgbere
- Bureau of Epidemiology, Houston Health Department, Houston, TX, USA
| | - Rajender Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Vinod S Bhatara
- Department of Psychiatry, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Joy P Alonzo
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
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Cummings JR, Ji X, Lally C, Druss BG. Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth. J Am Acad Child Adolesc Psychiatry 2019; 58:128-138. [PMID: 30577928 PMCID: PMC8051617 DOI: 10.1016/j.jaac.2018.04.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/04/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth. METHOD Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. RESULTS Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). CONCLUSION The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.
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Affiliation(s)
| | - Xu Ji
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy Lally
- Rollins School of Public Health, Emory University, Atlanta, GA
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Jones AL, Mor MK, Haas GL, Gordon AJ, Cashy JP, Schaefer JH, Hausmann LRM. The Role of Primary Care Experiences in Obtaining Treatment for Depression. J Gen Intern Med 2018; 33:1366-1373. [PMID: 29948804 PMCID: PMC6082202 DOI: 10.1007/s11606-018-4522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown. OBJECTIVE In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression. DESIGN AND PARTICIPANTS We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients. MAIN MEASURES We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1. KEY RESULTS Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2. CONCLUSIONS In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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7
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Wei YJ, Simoni-Wastila L, Albrecht JS, Huang TY, Moyo P, Khokhar B, Harris I, Langenberg P, Netzer G, Lehmann SW. The association of antidepressant treatment with COPD maintenance medication use and adherence in a comorbid Medicare population: A longitudinal cohort study. Int J Geriatr Psychiatry 2018; 33:e212-e220. [PMID: 28833488 PMCID: PMC6362976 DOI: 10.1002/gps.4772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/12/2017] [Indexed: 11/10/2022]
Abstract
UNLABELLED The effect of treating comorbid depression to achieve optimal management of chronic obstructive pulmonary disease (COPD) has not yet empirically tested. We examined the association between antidepressant treatment and use of and adherence to COPD maintenance medications among patients with new-onset COPD and comorbid depression. METHODS Using 2006-2012 Medicare data, this retrospective cohort study identified patients with newly diagnosed COPD and new-onset major depression. Two exposures-antidepressant use (versus non-use) and adherence measured by proportion of days covered (PDC) (PDC ≥0.8 versus <0.8)-were assessed quarterly. We used marginal structural models to estimate the effects of prior antidepressant use and adherence on subsequent COPD maintenance inhaler use and adherence outcomes, accounting for time-varying confounders. RESULTS A total of 25 458 COPD-depression patients, 82% with antidepressant treatment, were followed for a median of 2.5 years. Nearly half (48%) used at least 1 COPD maintenance inhaler in any given quarter; among users, 3 in 5 (61%) had a PDC of <0.8. Compared to patients with no antidepressant treatment, those with antidepressant use were more likely to use (relative ratio [RR] = 1.15, 95% confidence interval [CI] = 1.12- 1.17) and adhere to (RR = 1.08, 95% = 1.03-1.14) their COPD maintenance inhalers. Patients who adhered to antidepressant treatment were more likely to use and adhere to COPD maintenance inhalers. CONCLUSION Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication-taking behaviors among COPD patients comorbid with depression.
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Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ting-Ying Huang
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Patience Moyo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Bilal Khokhar
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Ilene Harris
- IMPAQ International LLC, Columbia, Maryland, USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan W. Lehmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bhattacharya R, Shen C, Wachholtz AB, Dwibedi N, Sambamoorthi U. Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression. BMC Psychiatry 2016; 16:247. [PMID: 27431801 PMCID: PMC4950075 DOI: 10.1186/s12888-016-0964-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. METHODS We used multi-state Medicaid data (2000-2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. RESULTS Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. CONCLUSIONS Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.
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Affiliation(s)
| | - Chan Shen
- />Department of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX USA
- />Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1444, Houston, TX 77030 USA
| | - Amy B. Wachholtz
- />Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA USA
| | - Nilanjana Dwibedi
- />Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV USA
| | - Usha Sambamoorthi
- />Department of Social & Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV USA
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9
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Puyat JH, Kazanjian A, Goldner EM, Wong H. How Often Do Individuals with Major Depression Receive Minimally Adequate Treatment? A Population-Based, Data Linkage Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:394-404. [PMCID: PMC4910409 DOI: 10.1177/0706743716640288] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective: Depression is usually treated with antidepressants, psychotherapy, or both. In this study, we examined the extent to which individuals with depression receive minimally adequate treatment with regard to the use of antidepressants and psychotherapy. Method: Using population-based administrative data, we identified individuals with inpatient or outpatient diagnoses of depression and tracked their use of publicly funded mental health services within a 12-month period. We used mixed-effects logistic regression to assess the influence of patient-level characteristics and physician-level variations on the receipt of minimally adequate treatment. Results: A total of 108 101 individuals, predominantly women (65%) and urban residents (89%), were diagnosed with depression in 2010–2011. Of these, 13% received minimally adequate counseling/psychotherapy with higher proportions observed among men, younger individuals, and urban residents. In contrast, there were more who received minimally adequate antidepressant therapy (48%), with women, older individuals, and rural residents having the highest proportions. Overall, about 53% received either type of treatment, and the pattern of use was similar to that of antidepressant therapy. Mixed-effects logistic regression results indicate that these factors remain independent predictors of the receipt of minimally adequate depression care. Significant practice variations also exist, which determine patients’ receipt of minimally adequate care, particularly with respect to counseling or psychotherapy. Conclusions: Only about half of those with depression receive either minimally adequate counseling/psychotherapy or minimally adequate antidepressant therapy. Disparities also persist, affecting mostly men and younger individuals. A multifactorial approach is needed to improve access to and reduce variations in receipt of minimally adequate depression care.
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Affiliation(s)
- Joseph H. Puyat
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arminee Kazanjian
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elliot M. Goldner
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Valentine A, DeAngelo D, Alegría M, Cook BL. Translating disparities research to policy: a qualitative study of state mental health policymakers' perceptions of mental health care disparities report cards. Psychol Serv 2014; 11:377-87. [PMID: 25383993 PMCID: PMC4228957 DOI: 10.1037/a0037978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Report cards have been used to increase accountability and quality of care in health care settings, and to improve state infrastructure for providing quality mental health care services. However, to date, report cards have not been used to compare states on racial/ethnic disparities in mental health care. This qualitative study examines reactions of mental health care policymakers to a proposed mental health care disparities report card generated from population-based survey data of mental health and mental health care utilization. We elicited feedback about the content, format, and salience of the report card. Interviews were conducted with 9 senior advisors to state policymakers and 1 policy director of a national nongovernmental organization from across the United States. Four primary themes emerged: fairness in state-by-state comparisons; disconnect between the goals and language of policymakers and researchers; concerns about data quality; and targeted suggestions from policymakers. Participant responses provide important information that can contribute to making evidence-based research more accessible to policymakers. Further, policymakers suggested ways to improve the structure and presentation of report cards to make them more accessible to policymakers, and to foster equity considerations during the implementation of new health care legislation. To reduce mental health care disparities, effort is required to facilitate understanding between researchers and relevant stakeholders about research methods, standards for interpretation of research-based evidence, and its use in evaluating policies aimed at ameliorating disparities.
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Affiliation(s)
- Anne Valentine
- Center for Multicultural Mental Health Research, Cambridge Health Alliance
| | - Darcie DeAngelo
- Center for Multicultural Mental Health Research, Cambridge Health Alliance
| | - Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance
| | - Benjamin L Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance
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Carson NJ, Vesper A, Chen CN, Lê Cook B. Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups. Psychiatr Serv 2014; 65:888-96. [PMID: 24686538 PMCID: PMC4182296 DOI: 10.1176/appi.ps.201300139] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States. METHODS The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference. RESULTS Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge. CONCLUSIONS Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.
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Affiliation(s)
- Nicholas J Carson
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Andrew Vesper
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Chih-Nan Chen
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Benjamin Lê Cook
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
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12
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Agyemang AA, Mezuk B, Perrin P, Rybarczyk B. Quality of depression treatment in Black Americans with major depression and comorbid medical illness. Gen Hosp Psychiatry 2014; 36:431-6. [PMID: 24793895 PMCID: PMC4141460 DOI: 10.1016/j.genhosppsych.2014.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/13/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective was to evaluate how comorbid type 2 diabetes (T2DM) and hypertension (HT) influence depression treatment and to assess whether these effects operate differently in a nationally representative community-based sample of Black Americans. METHODS Data came from the National Survey of American Life (N=3673), and analysis is limited to respondents who met lifetime criteria for major depression (MD) (N=402). Depression care was defined according to American Psychiatric Association (APA) guidelines and included psychotherapy, pharmacotherapy and satisfaction with services. Logistic regression was used to examine the effects of T2DM and HT on quality of depression care. RESULTS Only 19.2% of Black Americans with MD alone, 7.8% with comorbid T2DM and 22.3% with comorbid HT reported APA-guideline-concordant psychotherapy or antidepressant treatment. Compared to respondents with MD alone, respondents with MD+T2DM/HT were no more or less likely to receive depression care. Respondents with MD+HT+T2DM were more likely to report any guideline-concordant care (odds ratio=3.32; 95% confidence interval, 1.07-10.31). CONCLUSIONS Although individuals with MD and comorbid T2DM+HT were more likely to receive depression care, guideline-concordant depression care is low among Black Americans, including those with comorbid medical conditions.
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Affiliation(s)
- Amma A Agyemang
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018 806 West Franklin Street, Richmond, VA 23284-2018.
| | - Briana Mezuk
- Department of Epidemiology and Community Health, Virginia Commonwealth University
| | - Paul Perrin
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018 806 West Franklin Street, Richmond, VA 23284-2018
| | - Bruce Rybarczyk
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018 806 West Franklin Street, Richmond, VA 23284-2018
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13
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Saloner B, Carson N, Cook BL. Episodes of mental health treatment among a nationally representative sample of children and adolescents. Med Care Res Rev 2014; 71:261-79. [PMID: 24399817 PMCID: PMC7650337 DOI: 10.1177/1077558713518347] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite renewed national interest in mental health care reform, little is known about treatment patterns among youth in the general population. Using longitudinal data from the Medical Expenditure Panel Survey, we examined both initiation and continuity of mental health treatment among 2,576 youth aged 5 to 17 with possible mental health treatment need (defined as a high score on a parent-assessed psychological impairment scale, fair/poor mental health status, or perceived need for counseling). Over a 2-year period, fewer than half of sampled youth initiated new mental health treatment. Minority, female, uninsured, and lower-income youth were significantly less likely to initiate care. Only one third of treatment episodes met criteria for minimal adequacy (≥4 provider visits with psychotropic medication treatment or ≥8 visits without medication). Episodes were significantly shorter for Latino youth. Efforts to strengthen mental health treatment for youth should be broadly focused, emphasizing not only screening and access but also treatment continuity.
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14
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Cook BL, Zuvekas SH, Carson N, Wayne GF, Vesper A, McGuire TG. Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Serv Res 2014; 49:206-29. [PMID: 23855750 PMCID: PMC3844061 DOI: 10.1111/1475-6773.12095] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. STUDY DESIGN We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination). FINDINGS Compared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care. CONCLUSIONS Disparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks' higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks' greater acute mental health care use raises concerns over monitoring of their treatment.
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Affiliation(s)
- Benjamin Lê Cook
- Address correspondence to Benjamin Lê Cook, Ph.D., M.P.H., Department of Psychiatry, Harvard Medical School, Center for Multicultural Mental Health Research, 120 Beacon Street, 4th Floor, Somerville,MA02143; e-mail: . Samuel H. Zuvekas, Ph.D., is with the Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD. Nicholas Carson, M.D., F.R.C.P.C., is with the Department of Psychiatry, HarvardMedical School, Center for MulticulturalMental Health Research, Somerville, MA.Geoffrey Ferris Wayne, M.A., is with the Center for Multicultural Mental Health Research, Somerville, MA. AndrewVesper, Ph.D., is with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Thomas G. McGuire, Ph.D., is with the Department of Health Care Policy, Harvard Medical School, Boston, MA
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15
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Traeger L, Cannon S, Pirl WF, Park ER. Depression and undertreatment of depression: potential risks and outcomes in black patients with lung cancer. J Psychosoc Oncol 2013; 31:123-35. [PMID: 23514250 DOI: 10.1080/07347332.2012.761320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the United States, Black men are at higher risk than White men for lung cancer mortality whereas rates are comparable between Black and White women. This article draws from empirical work in lung cancer, mental health, and health disparities to highlight that race and depression may overlap in predicting lower treatment access and utilization and poorer quality of life among patients. Racial barriers to depression identification and treatment in the general population may compound these risks. Prospective data are needed to examine whether depression plays a role in racial disparities in lung cancer outcomes.
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Affiliation(s)
- Lara Traeger
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital, Boston, MA, USA.
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16
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Stein BD, Sorbero MJ, Dalton E, Ayers AM, Farmer C, Kogan JN, Goswami U. Predictors of adequate depression treatment among Medicaid-enrolled youth. Soc Psychiatry Psychiatr Epidemiol 2013; 48:757-65. [PMID: 23589098 DOI: 10.1007/s00127-012-0593-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 09/12/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment. METHODS We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6-24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930). RESULTS Fifty-nine percent of depressed youth received minimally adequate psychotherapy, but 13 % received minimally adequate pharmacotherapy. Youth who began their treatment episode with an inpatient psychiatric stay for depression and racial minorities were significantly less likely to receive minimally adequate pharmacotherapy and significantly more likely to receive inadequate overall treatment. CONCLUSIONS While the majority of youth appear to be receiving minimally adequate acute care for depression, a substantial number are not. Given current child mental health workforce constraints, efforts to substantially improve the provision of adequate care to depressed youth are likely to require both quality improvement and system redesign efforts.
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Affiliation(s)
- Bradley D Stein
- Community Care Behavioral Health Organization, Pittsburgh, USA.
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Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence. Community Ment Health J 2013; 49:185-92. [PMID: 22837104 DOI: 10.1007/s10597-012-9528-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.
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Fontanella CA, Bridge JA, Marcus SC, Campo JV. Factors associated with antidepressant adherence for Medicaid-enrolled children and adolescents. Ann Pharmacother 2011; 45:898-909. [PMID: 21775691 DOI: 10.1345/aph.1q020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antidepressants have been shown to be efficacious for the treatment of pediatric depression. However, many youths do not receive an adequate duration of treatment, and factors associated with nonadherence in this population remain poorly understood. OBJECTIVE To examine rates of antidepressant adherence for depressed youth and identify factors associated with adherence during the acute and continuation phases of treatment. METHODS A retrospective cohort analysis was conducted using claims data from a state Medicaid-enrolled population of 1650 youths (aged 5-17 years) with new episodes of depression between January 1, 2005, and December 30, 2007. These patients were treated with selective serotonin reuptake inhibitors or newer antidepressants and followed for 6 months from the first prescription fill date. Adherence measures were derived from the Health Plan Employer Data and Information Set (HEDIS) quality indicators on antidepressant management (3 months of continuous treatment for the acute phase and 6 months for the continuation phase) and assessed using the medication possession ratio. Multivariate logistic regression analyses evaluated the association between demographic, clinical, medication, and treatment factors, and adherence. RESULTS About half (49.5%) of the youths were adherent to antidepressant medication during the acute phase, and 42% of these were adherent during the continuation phase; 21% were adherent across both treatment phases. Optimal follow-up visits and adequate antidepressant dosing was associated with better adherence during both treatment phases, as was use of other psychotropic medications. Youths prescribed trazodone for sleep had higher adherence rates during the acute phase. Minority youths and adolescents had lower adherence rates during the acute phase. Youths in foster care had higher adherence rates during both treatment phases. CONCLUSIONS Nonadherence with antidepressant medications is common among Medicaid-covered children and adolescents. Study findings underscore the need for clinicians to deliver guideline-concordant care, assess adherence, and develop interventions that improve adherence, particularly for vulnerable subgroups.
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Affiliation(s)
- Cynthia A Fontanella
- College of Social Work and Department of Psychiatry, The Ohio State University, Columbus, OH, USA.
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Abstract
OBJECTIVE To examine the effect of depression treatment on medical and social outcomes for individuals with chronic pain and depression. People with chronic pain and depression have worse health outcomes than those with chronic pain alone. Little is known about the effectiveness of depression treatment for this population. METHODS Propensity score-weighted analyses, using both waves (1997-1998 and 2000-2001) of the National Survey of Alcohol, Drug, and Mental Health Problems, were used to examine the effect of a) any depression treatment and b) minimally adequate depression treatment on persistence of depression symptoms, depression severity, pain severity, overall health, mental health status, physical health status, social functioning, employment status, and number of workdays missed. Analyses were limited to those who met Composite International Diagnostic Interview Short-Form criteria for major depressive disorder, reported having at least one chronic pain condition, and completed both interviews (n = 553). RESULTS Receiving any depression treatment was associated with higher scores on the mental component summary of the Medical Outcomes Study Short Form-12, indicating better mental health (difference = 2.65 points, p = .002) and less interference of pain on work (odds ratio = 0.57, p = .02). Among those receiving treatment, minimal adequacy of treatment was not significantly associated with better outcomes. CONCLUSIONS Depression treatment improves mental health and reduces the effects of pain on work among those with chronic pain and depression. Understanding the effect of depression treatment on outcomes for this population is important for employers, healthcare providers treating this population, and policymakers working in this decade of pain control and research to improve care for chronic pain sufferers.
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