Guideline-concordant antidepressant use among patients with major depressive disorder☆
Received 20 December 2009; accepted 15 March 2010. published online 28 April 2010.
Abstract
Objectives
To examine whether prescriber specialty and guideline-concordant follow-up visits were associated with antidepressant treatment completion among patients with major depressive disorder (MDD).
Methods
This study analyzed medical and prescription claims from a large national health plan. Patients were grouped based on initial prescriber specialty. Receipt of guideline-concordant follow-ups was defined as having ≥3 visits during the treatment phase. Completion of acute phase (first 90 days) and continuation phase (Days 91–270) was defined by adherence ≥80% without significant gaps in treatment. Logistic regressions were used to examine factors associated with treatment completion.
Results
Forty-seven percent of the 4102 newly diagnosed patients completed the acute phase, 45% of whom also completed the continuation phase. Among those initially prescribed by primary care providers (PCPs), patients with guideline-concordant follow-ups were more likely (13.1 percentage points, P<.0001) to complete acute phase than patients without guideline-concordant follow-ups. Receipt of guideline-concordant follow-ups increased the probability of acute phase completion by an additional 6.8 percentage points if initially treated by psychiatrists. Patients prescribed by psychiatrists were less likely to complete acute phase treatment (−4.6 percentage points, P=.04) if they did not have guideline-concordant follow-ups.
Conclusion
A large gap remains between guideline recommendations and actual antidepressant treatment. Frequent follow-up corresponds with better antidepressant adherence.
aAbt Bio-Pharma Solutions, Inc., Lexington, MA 02421, USA
bDivision of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA
cDepartment of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
dCecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
eDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
fCenter for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
gDivision of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
☆ Conflict of interest statement: Dr. Hansen is supported by grant KL2RR025746 from the National Center for Research Resources. A portion of this work was funded by the American Association of Colleges of Pharmacy New Investigator Program (NIP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources, the National Institutes of Health or the American Association of Colleges of Pharmacy. Dr. Chen is employed by Abt Bio-Pharma Solutions. Dr. Hansen has received consulting fees from Takeda Pharmaceuticals. Dr. Farley has received grant funding from the Pfizer Foundation and consulting fees from Takeda Pharmaceuticals. Dr. Gaynes has received grants and research support from M-3 Information, Bristol-Myers Squibb Company and Novartis, and he has served as an advisor for Bristol-Myers Squibb Company. The other authors report no competing interests.
ABSTRACT