|Title||Antidepressant Medication Management Among Older Patients Receiving Home Health Care.|
|Publication Type||Journal Article|
|Year of Publication||2015|
|Authors||Bao Y, Shao H, Bruce ML, Press MJ|
|Journal||Am J Geriatr Psychiatry|
|Date Published||2015 Oct|
|Keywords||Aged, 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 Journal||Am J Geriatr Psychiatry|
|PubMed Central ID||PMC4291306|
|Grant List||K01 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