Guideline-concordant antidepressant use among patients with major depressive disorder☆

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.

Keywords: Depression, Antidepressants, Provider specialty, Clinical guideline, Follow-up visits