Friday, January 11, 2019

Study Suggests Actions to Improve Compliance With Depression Treatment

Treatment guideline recommendations are not being followed for a large proportion of patients with major depressive disorder, suggests a study published today in Psychiatric Services in Advance. The authors suggest that improvement in multiple areas—such as treatment practices and health insurance coverage—are needed.

“Our research found that most patients were not receiving antidepressants or psychotherapy after the first five months following their initial diagnosis of major depressive disorder,” wrote Fraser W. Gaspar, Ph.D., M.P.H., of MDGuidelines, a health care consulting organization, and colleagues. “Furthermore, when treatment was utilized, antidepressant and psychotherapy adherence was low, and the starting antidepressant dosages were often outside guideline recommendations.”

The study analyzed claims data from the 2007-2016 records of IBM MarketScan research databases for nearly 25,000 patients whose ICD (International Classification of Diseases) code indicated a diagnosis of “single-episode, major depressive disorder.” The MarketScan population is drawn from a sample of employees who mostly work for larger employers and have employer-provided health insurance. Researchers tracked use of pharmacotherapy and psychotherapy and analyzed drug codes attached to each participant’s pharmaceutical claims to determine the strength and class of prescribed antidepressants.

The study’s major findings include the following:

  • Most patients (55%) had discontinued all treatment, both psychotherapy and medication, by the fifth month after being diagnosed with major depressive disorder.
  • A shorter time from diagnosis to treatment and a lower percentage of out-of-pocket costs paid by the patient were associated with increased medication adherence and intensive psychotherapy use. In contrast, participants in high-deductible and consumer-driven health plans were most likely to receive no treatment or treatment with a prescription only.
  • About one-third of patients were prescribed dosages outside of the dosing regimen noted in the APA Practice Guideline for the Treatment of Major Depressive Disorder, with more dosages below the recommendation (23%) than above (11%). However, the authors noted some of the variance might reflect off-label use of the medications.
  • Less than half of patients with depression were adherent to antidepressant treatment in the acute and continuation phases (defined as approximately the first four months and eight months, respectively, after starting treatment). Patients with greater depression severity had significantly lower adherence rates, the authors noted.

“Modifiable characteristics, such as starting treatment immediately after diagnosis of major depressive disorder and lowering out-of-pocket expenses, were associated with antidepressant adherence and intensive psychotherapy utilization. Furthermore, patients who used mail-order prescriptions for antidepressants had higher odds of adherence,” the authors wrote. Since increased cost sharing cut pharmaceutical adherence, health policymakers should consider expanding mental health benefits to improve overall savings attributable to improved health outcomes, the authors noted.

For related information, see the Psychiatric News article “Refusal, Dropout Rates Differ Between Patients Receiving Psychotherapy, Pharmacotherapy.”

(Image: iStock/FilippoBacci)


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