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Antidepressant Medication Management Among Older Patients Receiving Home Health Care.

TitleAntidepressant Medication Management Among Older Patients Receiving Home Health Care.
Publication TypeJournal Article
Year of Publication2015
AuthorsBao Y, Shao H, Bruce ML, Press MJ
JournalAm J Geriatr Psychiatry
Date Published2015 Oct
KeywordsAged, Aged, 80 and over, Antidepressive Agents, Cooperative Behavior, Depression, Female, Health Knowledge, Attitudes, Practice, Home Care Services, Humans, Logistic Models, Male, Medicare, Medication Therapy Management, Office Visits, Outcome Assessment (Health Care), Physician-Nurse Relations, Retrospective Studies, United States

OBJECTIVE: Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay.

METHODS: Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients aged 65 years or older who received HHC in 2006-2007 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (versus discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy.

RESULTS: About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10- to 20-percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change.

CONCLUSIONS: Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.

Alternate JournalAm J Geriatr Psychiatry
PubMed ID25158915
PubMed Central IDPMC4291306
Grant ListK01 MH090087 / MH / NIMH NIH HHS / United States
R03MH085834 / MH / NIMH NIH HHS / United States
R01 MH096441 / MH / NIMH NIH HHS / United States
P30 MH085943 / MH / NIMH NIH HHS / United States
K01MH090087 / MH / NIMH NIH HHS / United States
R03 MH085834 / MH / NIMH NIH HHS / United States
P30MH085943 / MH / NIMH NIH HHS / United States
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