Continuity of Care and Adherence to Antidepressant Treatment Among Medicaid-Covered Youth

Abstract

Continuity of care is a critical indicator of quality of care and key to effective antidepressant medication management in children and adolescents. Little is known about the characteristics associated with receiving guidelines concordant care. Using a retrospective, longitudinal cohort design of youth with a new episode of depression, this study reviewed records and pre-existing data to (1) examine rates of conformance to continuity of care treatment guidelines (Health Plan Employer Data and Information Set [HEDIS]) for antidepressant management; (2) identify individual- and community-level characteristics associated with continuity of antidepressant treatment; and (3) investigate the relationship between continuity of care and antidepressant adherence. Two-thirds of youth met the HEDIS optimum contact criteria of three outpatient mental health contacts during the first 3 months of treatment. Good continuity of care was associated with prior outpatient treatment and taking other psychotropic medications while inadequate follow-up was associated with older adolescents, disabled children, and youths living in rural areas. Guidelines concordant follow-up was associated with better antidepressant adherence. Findings underscore the need to deliver guidelines concordant care, particularly among vulnerable subgroups.