Does Consideration of Medicare Use Affect VA Evaluations of Treatment for New Episodes of Depression?

McCarthy, John F.; Zivin, Kara; Austin, Karen; Kales, Helen C.; Valenstein, Marcia

doi:10.1007/s10488-008-0190-y

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…Therefore, the impacts of non‐VA use may be minimal for mental health care because of high reliance on VA for this type of care. Our study concurs with other recent research on this question (McCarthy et al 2008).…”

Section: Discussionsupporting

confidence: 94%

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Liu

Chapko

Bryson

et al. 2010

Health Services Research

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Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care.

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Section: Discussionsupporting

confidence: 94%

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Liu

Chapko

Bryson

et al. 2010

Health Services Research

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“…We did not measure guideline-concordant antidepressant treatment, degree of adverse event monitoring, or use of other psychiatric or medical services that may moderate the relationship between antidepressant use and outcomes (36). We examined medication use as prescribed, but as with all pharmacoepidemiology studies, we are unable to verify actual ingestion of medication.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the FDA Warning Against Prescribing Citalopram at Doses Exceeding 40 mg

Zivin¹,

Pfeiffer²,

Bohnert³

et al. 2013

AJP

Self Cite

108

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This large study found no elevated risks of ventricular arrhythmia or all-cause, cardiac, or noncardiac mortality associated with citalopram dosages >40 mg/day. Higher dosages were associated with fewer adverse outcomes, and similar findings were observed for a comparison medication, sertraline, not subject to the FDA warning. These results raise questions regarding the continued merit of the FDA warning.

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“…(Valenstein et al, 2006) However, for patients using mental health services, rates of cross-system use outside the VA are low. (Desai, Rosenheck, & Rothbard, 2001; Desai & Rosenheck, 2002; McCarthy, Zivin, Austin, Kales, & Valenstein, 2008) We note that we did not examine whether patients were taking antidepressants prior to hospitalization and among those patients who were, whether they were more or less adherent to their medications prior to hospitalization. We chose instead to focus on an understudied high-risk period post hospitalization, as there has been substantial literature focused on antidepressant adherence in the absence of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Antidepressant Adherence After Psychiatric Hospitalization Among VA Patients with Depression

Zivin

Ganoczy²,

Pfeiffer

et al. 2009

Adm Policy Ment Health

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Objective-Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization.Method-We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within three and six months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs <0.8) after discharge.Results-20,931 and 23,182 patients met criteria for three and six month MPRs. The mean three month MPR was 0.79 (s.d.=0.37). The mean six month MPR was 0.66 (s.d.=0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders.Conclusion-Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients.

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Does Consideration of Medicare Use Affect VA Evaluations of Treatment for New Episodes of Depression?

Cited by 6 publications

References 24 publications

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Evaluation of the FDA Warning Against Prescribing Citalopram at Doses Exceeding 40 mg

Antidepressant Adherence After Psychiatric Hospitalization Among VA Patients with Depression

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