OBJECTIVES To examine the evolution of depression identification and use of antidepressants in elderly long-stay nursing home residents from 1999 through 2007, and the associated sociodemographic and facility characteristics. DESIGN Annual cross-sectional analysis of merged resident assessment data from the Minimum Data Set (MDS) and facility characteristics from the Online Survey Certification and Reporting (OSCAR) data. SETTING Nursing homes in eight states (5,445 facilities). PARTICIPANTS Long-stay nursing home residents aged 65 and over (2,564,687 assessments). MEASUREMENTS Physician-documented depression diagnoses recorded in the MDS were used to identify residents with depression; antidepressant use was measured by MDS information about a resident’s receipt of an antidepressant in the seven days prior to assessment. RESULTS Both diagnosis of depression and antidepressant therapy among those diagnosed increased at a rapid rate. By 2007, 51.8% of residents were diagnosed with depression, among whom 82.8% received an antidepressant. Adjusted odds of treatment were higher for younger residents, whites, and those with moderate impairment of cognitive function. CONCLUSION This study demonstrates striking increases in depression diagnosis and treatment with antidepressant medications; however, disparities persist without clear evidence about underlying mechanisms. More research is needed to assess effectiveness of antidepressant prescribing.

High depression rates at admission and during the first year indicate a need to monitor and treat large numbers of American LTNH residents for depression. Reduced associations between demographics and depression as stays progress suggest other factors have increased roles in depression etiology.

ObjectivesMedical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. MethodsData are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. ResultsWeighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). ConclusionsCSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

No abstract

No abstract