Disparities in the Adequacy of Depression Treatment in the United States Jeffrey S. Harman, Ph.D. University of Florida Mark J. Edlund, M.D., Ph.D. John C. Fortney, Ph.D. Central Arkansas Veterans Healthcare System University of Arkansas for Medical Sciences This research was funded by NIMH (K01-MH63780)
26
Embed
Disparities in the Adequacy of Depression Treatment in the United States Jeffrey S. Harman, Ph.D. University of Florida Mark J. Edlund, M.D., Ph.D. John.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Disparities in the Adequacy of Depression Treatment in the
United States
Jeffrey S. Harman, Ph.D.
University of Florida
Mark J. Edlund, M.D., Ph.D.
John C. Fortney, Ph.D.
Central Arkansas Veterans Healthcare System
University of Arkansas for Medical Sciences
This research was funded by NIMH (K01-MH63780)
Depression in the U.S.
• Depression is common, costly, and impacts functioning, quality of life
• Effective treatments exist• National treatment guidelines have
been developed• Estimated that only 7% to 30% receive
adequate treatment
Disparities in Treatment
• Studies have shown that some populations especially vulnerable to under-treatment– African-Americans, ethnic minorities– Older persons, young adults– Medicaid beneficiaries, uninsured
• These studies were limited– Most are not nationally representative– Most do not distinguish between initiation vs.
persistence
Purpose of Study
• To use nationally representative data to examine disparities in depression treatment by age, race/ethnicity, insurance coverage– Compare rates of initiating treatment– Compare rates of adequate treatment
among those who initiated treatment
Data
• Data are from the 2000 Medical Expenditure Panel Survey (MEPS)– Nationally representative– Sponsored by the Agency for Healthcare
Research and Quality– Collects information on health care use
and expenses, health status, health insurance coverage, demographics, etc
Individuals with Depression
• Individuals with depression identified using 2000 MEPS Medical Condition File– Contains observation for each self-reported
medical condition during the year
• Self-reported conditions were mapped onto a 3-digit ICD-9 code by coders
• All individuals with ICD-9 codes of 296 or 311 were included in the analysis– N = 1,347
Antidepressant Treatment
• Identified using 2000 Prescribed Medicine Event File– Each event represents one prescription
• Antidepressants identified by drug name• Daily dosage calculated using pill dosage and
number of pills– Assumed 30 day supply unless < 30 pills
• Compared to minimally adequate daily dosage (Weilburg et al., 2003)
Psychotherapy/MH Counseling
• Psychotherapy or MH counseling identified using MEPS event files – 2000 Outpatient Visit File – 2000 Office-Based Medical Provider Visit File
• Respondent asked to identify which category best described care provided during visit– One category was “Psychotherapy or Mental
Health Counseling”
Adequacy of Treatment
• Adequate depression treatment over one-year period defined as:– At least 4 antidepressant prescriptions at the
minimum adequate daily dosage– At least 8 psychotherapy/MH counseling visits
• Definition based on treatment guidelines and similar to that used by Kessler et al. (2003)
Patient Characteristics
• Race/ethnicity consisted of 4 mutually exclusive categories– Caucasian, African-American, Hispanic, Other
• Age categorized into 4 groups– Under 18, 18-34, 35-64, and 65+