Determinants of follow-up care associated with incident antidepressant use in older adults

Abstract

ObjectivesTo determine the proportion of older adults receiving guideline concordant antidepressant therapy and to determine patient, prescriber and organizational factors associated with adequate antidepressant therapy.MethodsThe study included secondary analyses of data collected in the Étude sur la Santé des Aînés (ESA) Services study on older adults recruited while consulting in primary care clinics in one of the largest health regions of the province of Québec. Antidepressant users (n = 349) were identified from information collected from the Régie de l’Assurance Maladie du Québec (RAMQ) pharmaceutical database which holds information on all drugs dispensed to all residents covered under the public drug plan. Adequacy of antidepressant treatment was measured using three criteria: adequacy of daily dose; length of prescription (≥455 days); and ≥3 visits to the antidepressant-prescribing physician in the first 3 months after initiation of therapy. Multivariate logistic regression analyses were used to study antidepressant treatment adequacy as a function of individual, provider and healthcare system factors.ResultsAmong the antidepressant users, 44% received an adequate antidepressant treatment filling all three criteria. None of the factors studied were associated with the probability of receiving adequate treatment filling all three criteria. Psychological distress was associated with having an adequate number of visits in the 3 months following initiation. Males and those living in a metropolitan and urban area were less likely to receive an adequate dose.ConclusionsFuture research should consider factors associated with perceived effectiveness and patient treatment preferences that may explain receipt of adequate antidepressant treatment in older adults.

Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults

“…Research has shown that over 50% of adult patients with depression or anxiety disorders do not receive guideline-concordant treatment [15][16][17][18]. Among older adults receiving antidepressant therapy, only 44% received an adequate dose and duration and had an appropriated number of physician follow-up visits [19].…”

The relationship between relational continuity and family physician follow-up after an antidepressant prescription in older adults: a retrospective cohort study

“…Houle et al [ 8 ] also found that people 65 years of age and older were less likely to receive follow-up care and to have high levels of continuity with their regular provider, but they did not assess the relationship between continuity and follow-up. Massamba et al [ 25 ] used survey data to assess follow-up care after a first antidepressant prescription in older adults in Quebec. They did not observe any differences in the Usual Provider of Care Index – a measure of continuity of care that calculates the proportion of visits performed by the provider that the patient visited most frequently – between older adults who received follow-up care and those who did not.…”