Abstract
ObjectivesTo determine the proportion of older adults receiving guideline concordant antidepressant therapy and to determine patient, prescriber and organizational factors associated with adequate antidepressant therapy.MethodsThe study included secondary analyses of data collected in the Étude sur la Santé des Aînés (ESA) Services study on older adults recruited while consulting in primary care clinics in one of the largest health regions of the province of Québec. Antidepressant users (n = 349) were identified from information collected from the Régie de l’Assurance Maladie du Québec (RAMQ) pharmaceutical database which holds information on all drugs dispensed to all residents covered under the public drug plan. Adequacy of antidepressant treatment was measured using three criteria: adequacy of daily dose; length of prescription (≥455 days); and ≥3 visits to the antidepressant-prescribing physician in the first 3 months after initiation of therapy. Multivariate logistic regression analyses were used to study antidepressant treatment adequacy as a function of individual, provider and healthcare system factors.ResultsAmong the antidepressant users, 44% received an adequate antidepressant treatment filling all three criteria. None of the factors studied were associated with the probability of receiving adequate treatment filling all three criteria. Psychological distress was associated with having an adequate number of visits in the 3 months following initiation. Males and those living in a metropolitan and urban area were less likely to receive an adequate dose.ConclusionsFuture research should consider factors associated with perceived effectiveness and patient treatment preferences that may explain receipt of adequate antidepressant treatment in older adults.
Highlights
The literature in the United States has shown that less than 50% of depressed older adults receive antidepressant therapy [1, 2] and among those who do, studies have reported that antidepressant prescribing patterns are inconsistent with treatment recommendations regarding dosage, duration and monitoring with follow-up visits [1].Inadequate antidepressant treatment for depression undermines the effectiveness of treatment for the individual including an increased risk of recurrenceStudies examining adequacy of antidepressant treatment, using quality indicators that include adequate dose, adequate duration and follow-up visits in older adult populations seen in general medical practice settings is limited [7]
Healthcare system facilitating factors such as mental health specialty, physician use of depression treatment algorithms, health insurance coverage and number of follow-up visits to the prescribing physician have been associated with receipt of adequate antidepressant therapy [9, 13, 14]
The analytic sample used in this study included respondents who were covered under the public drug insurance plan and who accepted that their survey data be linked to their Régie de l’Assurance Maladie du Québec (RAMQ) medical file and who had filled an antidepressant prescription (n = 349) (Fig. 2)
Summary
Studies examining adequacy of antidepressant treatment, using quality indicators that include adequate dose, adequate duration and follow-up visits in older adult populations seen in general medical practice settings is limited [7]. In older adults and mixed-age populations, on the adequacy of the antidepressant therapy have underlined a number of associated factors. Healthcare system facilitating factors such as mental health specialty, physician use of depression treatment algorithms, health insurance coverage and number of follow-up visits to the prescribing physician have been associated with receipt of adequate antidepressant therapy [9, 13, 14]. The adequacy and quality of antidepressant treatment in older adults following published guidelines [15] becomes an important issue in primary care and the efficiency of the health system. To determine patient, prescriber and organizational factors (Fig. 1) associated with adequate antidepressant therapy
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