Document Detail


Receiving guideline-concordant pharmacotherapy for major depression: impact on ambulatory and inpatient health service use.
MedLine Citation:
PMID:  17479528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study aimed to determine the associations between guideline-concordant pharmacotherapy for depression and the use of health services in the year following diagnosis. METHOD: This population-based, retrospective cohort study examined Quebec drug plans between 1999 and 2002. We included beneficiaries aged 18 to 64 years who were newly diagnosed with an episode of depression by primary care physicians and psychiatrists between October 1, 2000, and March 31, 2001, and who made at least one psychotropic pharmacy claim within 31 days of diagnosis. We defined guideline concordance as the receipt of recommended medication, starting dosage, and treatment duration as defined by the Canadian Network for Mood and Anxiety Treatments guidelines. We measured outcomes on use of ambulatory (number of visits to prescribing physician, other physicians, or emergency departments) and inpatient (hospitalization) services. RESULTS: There were 2742 patients (mean age 42 years; 64% female patients) who met the study criteria. Of the 2047 (75%) patients to whom an antidepressant was dispensed, 1958 (71%) received a recommended first-line medication, 1297 (63%) received a recommended starting dosage, and 304 (15%) received a recommended duration. According to the 3 criteria, only 8% were treated appropriately; 21% received benzodiazepines rather than antidepressants. There were 2 median visits (inferquartile range [IQR] 1 to 3) to prescribing physicians, 0 visits (IQR 0 to 1) to other physicians, and 0 visits (IQR 0 to 0) to emergency departments; 497 (18%) patients were hospitalized. In separate multivariate models for repeated measures, recommended first-line medication, dosage, and duration were associated with more prescribing physician visits. Recommended first-line medication reduced the odds of hospitalization. CONCLUSION: Guideline concordance was associated with more visits to prescribing physicians and lower odds of hospitalization.
Authors:
Maida J Sewitch; Régis Blais; Elham Rahme; Brian Bexton; Sophie Galarneau
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian journal of psychiatry. Revue canadienne de psychiatrie     Volume:  52     ISSN:  0706-7437     ISO Abbreviation:  Can J Psychiatry     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-05-07     Completed Date:  2007-07-05     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7904187     Medline TA:  Can J Psychiatry     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  191-200     Citation Subset:  IM    
Affiliation:
Department of Medicine, McGill University, Montreal, Quebec. maida.sewitch@mcgill.ca
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Ambulatory Care / methods*
Antidepressive Agents / therapeutic use*
Benzodiazepines / therapeutic use*
Canada
Cohort Studies
Depressive Disorder, Major / rehabilitation,  therapy*
Drug Prescriptions / statistics & numerical data
Female
Guideline Adherence / statistics & numerical data*
Hospitalization*
Humans
Male
Mental Health Services / standards*
Middle Aged
Practice Guidelines as Topic*
Psychotropic Drugs / therapeutic use*
Retrospective Studies
Chemical
Reg. No./Substance:
0/Antidepressive Agents; 0/Psychotropic Drugs; 12794-10-4/Benzodiazepines

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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