Fraser W Gaspar1, Catherine S Zaidel1, Carolyn S Dewa1. 1. MDGuidelines at ReedGroup, Ltd., Westminster, Colorado (Gaspar, Zaidel); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dewa).
Abstract
OBJECTIVE: Rates and determinants of pharmacological and psychotherapy use were assessed after a major depressive disorder diagnosis. METHODS: In a retrospective claims study that included 2007-2016 records from the IBM MarketScan research databases, use of pharmacotherapy and psychotherapy was tracked in a population of 24,579 patients with a diagnosis of major depressive disorder. Univariate and multiple variable analyses were used to identify determinants of antidepressant adherence (proportion of days covered ≥.8) and intensive psychotherapy at the beginning of treatment (at least four psychotherapy visits in the first 4 weeks after initiating psychotherapy). RESULTS: In the 12 months following a diagnosis of major depressive disorder, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). When antidepressants were initiated (N=13,524), 41.7% and 32.0% of patients were adherent in the acute and continuation phases, respectively. Initial antidepressant dosages were outside guideline recommendations for 34.5% of patients prescribed these medications. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use. CONCLUSIONS: Findings indicate that treatment guideline recommendations are not followed for a large proportion of patients with major depressive disorder and that improvement is needed in multiple areas to enhance effective treatment.
OBJECTIVE: Rates and determinants of pharmacological and psychotherapy use were assessed after a major depressive disorder diagnosis. METHODS: In a retrospective claims study that included 2007-2016 records from the IBM MarketScan research databases, use of pharmacotherapy and psychotherapy was tracked in a population of 24,579 patients with a diagnosis of major depressive disorder. Univariate and multiple variable analyses were used to identify determinants of antidepressant adherence (proportion of days covered ≥.8) and intensive psychotherapy at the beginning of treatment (at least four psychotherapy visits in the first 4 weeks after initiating psychotherapy). RESULTS: In the 12 months following a diagnosis of major depressive disorder, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). When antidepressants were initiated (N=13,524), 41.7% and 32.0% of patients were adherent in the acute and continuation phases, respectively. Initial antidepressant dosages were outside guideline recommendations for 34.5% of patients prescribed these medications. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use. CONCLUSIONS: Findings indicate that treatment guideline recommendations are not followed for a large proportion of patients with major depressive disorder and that improvement is needed in multiple areas to enhance effective treatment.
Authors: Gyeongseon Shin; Bohwa Jang; Green Bae; Ha-Lim Jeon; SeungJin Bae Journal: Int J Environ Res Public Health Date: 2022-09-05 Impact factor: 4.614