initiating antidepressant treatment

Size: px
Start display at page:

Download "initiating antidepressant treatment"

Transcription

1 Follow-Up Visits by Provider Specialty for Patients With Major Depressive Disorder Initiating Antidepressant Treatment Shih-Yin Chen, Ph.D. Richard A. Hansen, Ph.D. Joel F. Farley, Ph.D. Bradley N. Gaynes, M.D., M.P.H. Joseph P. Morrissey, Ph.D. Matthew L. Maciejewski, Ph.D. Dr. Chen is affiliated with Abt Bio-Pharma Solutions, Inc., 181 Spring St., Lexington, MA ( abtbiopharma.com). Dr. Hansen and Dr. Farley are with the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, Dr. Gaynes is with the Department of Psychiatry, and Dr. Morrissey is with Cecil G. Sheps Center for Health Services Research, all at the University of North Carolina at Chapel Hill. Dr. Maciejewski is with the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina. Objectives: This study examined the association between provider specialty and guideline-concordant care after the initiation of antidepressant treatment. Methods: Medical and prescription claims were analyzed from adults newly diagnosed as having major depressive disorder who initiated antidepressant treatment. Follow-up visits during the first 90 days after the index prescription were identified, and an indicator for receipt of guideline-concordant care (three or more visits) was created. Logistic regression models were used, and propensity score matching techniques were applied. Sensitivity analyses were conducted to investigate how results differed by varying the approach to identify followup visits. Results: The study included 4,102 patients, and only 31% received guideline-concordant follow-up visits. Patients receiving their initial prescription from psychiatrists were nearly five times as likely as patients receiving their initial prescription from primary care providers to receive guideline-concordant follow-up care (odds ratio=4.6, 95% confidence interval= ). Conclusions: Routine care for antidepressant management falls short of guideline recommendations, especially in primary care. (Psychiatric Services 61:81 85, 2010) Major depressive disorder is an important mental health problem that is associated with significant role impairment, mortality, and substantial costs to society (1). Antidepressants are the most frequently used therapy to treat depression because of their easy administration and relatively high effectiveness. Clinical practice guidelines from the Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research, and the American Psychiatric Association (APA) recommend frequent follow-up visits during the initiation of antidepressant treatment to provide patient support, adjust dosage, and monitor side effects and clinical response (2 4). Visits also should be frequent enough to promote treatment adherence and to reduce communication gaps between the treating physicians and patients about the anticipated duration of treatment. The APA guidelines recommend patients to be seen on a weekly basis during the first 90 days of treatment (2). The AHRQ guidelines recommend patients to be seen every ten to 14 days for the first six to eight weeks, or more frequently if they have more severe depression (4). Most patients with depression are treated in primary care settings (5). Three prior studies, which identified provider specialty from clinic types or service claims, found substantial differences in rates of follow-up visits between primary care and mental health specialty care settings (6 8). Identifying provider specialty by clinic type (for example, general internal medicine clinic versus mental health clinic) may be misleading because providers with various specialties may practice in a given clinic. Using medical claims as the source of provider specialty may not identify the physician providing antidepressant management. The objectives of this study were to examine the rate of receiving guideline-concordant follow-up visits among patients with major depressive disorder initiating antidepressant treatment and to evaluate whether this rate differs between patients initially given a prescription for antidepressants by primary care providers, by psychia- PSYCHIATRIC SERVICES ps.psychiatryonline.org January 2010 Vol. 61 No. 1 81

2 trists, or by nonpsychiatrist specialists. We identified provider specialty from the initial antidepressant prescription, because providers writing the index prescription were most likely to be the same provider in subsequent outpatient visits managing the antidepressant treatment. We also conducted sensitivity analyses to provide robustness of our overall results. Methods The study used medical and prescription claims from a large national health plan affiliated with i3 Innovus. Patients were included if they were diagnosed as having major depressive disorder between July 1, 2000, and December 31, 2002, by using the ICD-9-CM diagnosis codes in any diagnosis field; filled a second-generation antidepressant prescription within 45 days of the index diagnosis; and were continuously enrolled for at least six months before and two years after the index diagnosis. Patients were excluded if they were younger than 18 years, had service claims with an ICD-9-CM diagnosis code of bipolar disorder or schizophrenia during the study period, or had antidepressant claims during the six-month preindex period. Individuals with an overlapping supply of another antidepressant indicating augmented therapy were excluded, because these patients may require a different frequency of monitoring. Finally, patients with an unknown provider specialty in their index antidepressant prescription claim were excluded because of missing observations for the explanatory variable of interest. Follow-up visits were identified on the basis of outpatient service claims with mental health diagnosis codes (ICD-9-CM codes ) in any diagnosis field. Based on National Committee on Quality Assurance s Healthcare Effectiveness Data and Information Set (HEDIS) measures, patients were considered to have had minimum guideline-concordant follow-up visits if they received at least three follow-up visits during the first 90 days after the index antidepressant prescription and least one of the follow-up visits was with a provider with prescribing privileges (9). The main explanatory variable of interest was provider specialty. The index antidepressant prescription claim was identified, and the provider specialty code from that claim was used to identify the initial provider specialty. We used the prescription as the source of provider specialty because we assumed that patients received the initial antidepressant prescription from the providers who initiated and subsequently managed their antidepressant therapy. Provider specialty was categorized into three mutually exclusive groups: primary care providers, psychiatrists, and all other nonpsychiatrist specialists (for example, cardiologist, gastroenterologist, neurologist, and oncologist). To adjust for differences between patients seen by providers of different specialties, we included several covariates in the regression analyses. Demographic variables included age, gender, and region of residence. Median household income and percentage of population 25 years or older with a high school degree in the state of residence were included as proxies for socioeconomic status. A chronic disease score based on prescription claims during the six-month preindex period was calculated to adjust risk of comorbid health conditions (10). Preexisting comorbid psychiatric conditions, including anxiety and alcohol or drug abuse, were identified at baseline. An indicator for receiving pregnancy-related outpatient visits during the 90-day period was included in the model. Type of initial antidepressant was included to control for potential differences in side effect profiles that may result in later outpatient visits. Quarter of year in which treatment was initiated was controlled for as a proxy for seasonality. Health plan characteristics included in the model were copayment for primary care visits and whether the patient saw an initial prescriber who was paid on a capitated basis. The average number of follow-up visits was compared between provider specialty groups with two-tailed Student s t tests, and the proportion of patients with guideline-concordant follow-up visits was compared among provider specialty groups with Pearson s chi square statistics. Logistic regression models were used to evaluate the association between provider specialty and receipt of guidelineconcordant follow-up visits, with adjustment for patient and health plan characteristics. To control for confounding from imbalance in observed covariates, we implemented propensity score matching techniques to create comparable patient cohorts between primary care and mental health specialty settings (11). The results were similar between the original model and the propensity score matched model, so we present results from only the original model. Because the accuracy of the results may be contingent on how providers coded diagnoses, we conducted two sensitivity analyses to investigate how results may have differed by varying the approach used to identify followup visits from administrative claims data. The HEDIS measure requires that one of the three follow-up visits be with a prescribing provider, but patients are likely to have visits with nonprescribing providers (for example, psychologist or social worker) who would not be able to change a patient s antidepressant therapy. In the first sensitivity analysis, we tested whether considering only follow-up visits with a mental health diagnosis made to providers with prescribing privileges would change the results of the main analysis. We expected that by focusing only on the visits made to prescribing providers, the results would more closely represent the differences in visits to manage antidepressant therapy. Also, we thought that depression diagnosis could be underreported on the claims for various reasons. To understand how robust our results were in regard to this issue, we conducted a second sensitivity analysis. Our data allowed us to link the provider from antidepressant prescription claims to outpatient service claims based on encrypted provider identification. Visits, regardless of diagnosis code, that were made to the same provider who wrote the initial antidepressant prescription were identified. We counted these visits and the visits with a mental health diagnosis made to providers with prescribing privi- 82 PSYCHIATRIC SERVICES ps.psychiatryonline.org January 2010 Vol. 61 No. 1

3 leges (as used in the first sensitivity analysis) as the outcome in the second sensitivity analysis. On one hand, we relaxed the requirement for mental health diagnosis; on the other hand, we restricted the relaxation of the requirement to only the visits made to the provider who initially prescribed the antidepressants in order to ascertain some level of confidence that the issues about antidepressant treatment would likely be addressed during these visits. We expected this change in the definition of follow-up visits to be most evident for patients seen by primary care providers because psychiatric diagnoses are commonly undercoded in primary care to accommodate patients who may not want it recorded because of stigma (12). Institutional review board approval of this study was obtained from University of North Carolina at Chapel Hill. Results The final sample included 4,102 patients aged 18 years or older with major depressive disorder who initiated treatment with second-generation antidepressants. There were 2,441 patients (60%) whose index antidepressant prescription was written by a primary care provider, 1,443 (35%) whose index prescription was written by a psychiatrist, and 218 (5%) whose index prescription was written by a nonpsychiatrist specialist. Compared with patients who were initially given a prescription by primary care providers, patients with an initial prescription from psychiatrists were younger (mean±sd of 38±12 years versus 41±12 years) (p<.05) and patients with an initial prescription from nonpsychiatrist specialists had a higher chronic disease score (mean score of 1.95±1.00 versus 1.77±.79) (p<.05). (Chronic disease score was measured by prescription claims during six months prior. Scores ranged from.16 to 7.5 for the study sample, with higher scores representing a higher level of comorbidities.) The mean±sd number of followup visits in the entire sample was 2.64±3.06 during the first 90 days after the index prescription. When stratified by provider specialty, the mean number of follow-up visits was higher for patients with an initial prescription from psychiatrists (mean of 3.8 ±3.5 visits; median of two visits) and for patients with an initial prescription from nonpsychiatrist specialists (mean of 2.8±3.3 visits; median of one visit) than it was for patients with an initial prescription from primary care providers (mean of 2.0±2.6 visits; median of one visit) (p<.05 for both). Overall, 1,265 patients (31%) received guideline-concordant follow-up visits. When stratified by provider specialty, the proportion was significantly higher for the psychiatrist group (N=745, 52%) and the nonpsychiatrist specialists group (N=58, 27%) than it was for the primary care providers group (N=464, 19%) (p<.05 for both). In adjusted analyses, patients were Table 1 more likely to receive guideline-concordant follow-up visits if they received their initial prescription for an antidepressant from psychiatrists (odds ratio [OR]=4.6, 95% confidence interval [CI]= ) or from nonpsychiatrist specialists (OR=1.5, CI= ) than they were if they received their initial prescription from primary care providers (Table 1). Patients were less likely to receive guideline-concordant follow-up visits if they were older than 50 years (50 64 years, OR=.77, CI=.62.96; 65 years or older, OR=.3, CI=.1.6) and if their copayment for primary care visits was more than $20 (OR=.6, CI=.4.9). Patients who had preexisting comorbid anxiety disorders were more likely than those without them to receive guideline-concordant fol- Logistic regression for receipt of guideline-concordant follow-up visits among 4,102 patients with major depression who initiated antidepressant treatment a First sensitivity Second sensitivity Main analysis analysis analysis Variable OR 95% CI OR 95% CI OR 95% CI Type of provider (reference: primary care provider) Psychiatrist Nonpsychiatric specialist Age group (reference: 18 34) Male Chronic disease score Anxiety Alcohol or drug abuse Capitated initial prescriber Copayment for primary care provider (reference: $0) $1 $ >$ Initial antidepressant (reference: fluoxetine) Bupropion Citalopram Escitalopram Mirtazapine Paroxetine Sertraline Venlafaxine a Region of residence, proxies for income and education, pregnancy-related visits in acute phase, and quarter of year were also controlled for. Main analyses used the Healthcare Effectiveness Data and Information Set measure for guideline-concordant care (three follow-up visits with a mental health diagnosis within 90 days, one of which is with a provider with prescribing privileges). The first sensitivity analysis restricted visits to only those made to providers with prescribing privileges. The second sensitivity analysis added visits made to the initial prescriber (regardless of the diagnostic code) to the visits used in the first sensitivity analysis. PSYCHIATRIC SERVICES ps.psychiatryonline.org January 2010 Vol. 61 No. 1 83

4 low-up visits (OR=1.8, CI= ). In the first sensitivity analysis that limited the visits coded with a mental health diagnosis only to those made to providers with prescribing privileges, we found that results were nearly identical to those in the main model (Table 1). In the second sensitivity analysis that added visits made to the same provider who wrote the initial antidepressant prescription, regardless of diagnosis, to the visits in the first sensitivity analysis, the odds ratio for receiving guideline-concordant follow-up visits among psychiatrists became much smaller but was still significant (OR=2.3, CI= ). The odds ratio for nonpsychiatrist specialists became nonsignificant. Discussion The study used a large claims database to examine whether patients with major depressive disorder treated with antidepressants received guideline-concordant care (according to the HEDIS measure of three or more follow-up visits within 90 days) and whether these visit rates differed by provider specialty. The findings from this study suggest that follow-up visits are underutilized by all providers 31% of all patients received guideline-concordant followup care. Patients who were given an initial prescription for an antidepressant by a psychiatrist were more likely than those who were given such a prescription by a primary care provider to have guideline-concordant follow-up (52% versus 19%, p<.05). However, it should be noted that nearly half of the patients who were seen initially by psychiatrists did not receive guideline-concordant care. This unadjusted difference was confirmed in adjusted analyses that controlled for patient, provider, and health plan factors, which is consistent with prior studies that used different definitions for provider specialty (6,7). In light of the differences between these types of providers, this study provides additional evidence highlighting the need for new care models that promote close management to maximize antidepressant effectiveness (13). Previous studies have highlighted patient, provider, and health system barriers to providing guideline-concordant care (14), but further investigation is needed to fully understand these barriers, including assessment of provider differences in attitudes toward and knowledge of depression treatment and knowledge about guidelines. The findings also underscore the need to improve follow-up for patients with depression managed in primary care settings, because it is neither efficient nor realistic to channel all patients with depression into specialty care. Rather, the goal should be to improve management of depression in primary care. Indeed, when guideline-concordant care is provided, depression outcomes in primary care and psychiatric settings appear equivalent (15). As with prior studies, this analysis identified follow-up visits by service claims that had a mental health diagnosis code. Depression is a common disease that is underdiagnosed in primary care, and patients might not want it to be recorded because of stigma (12). It is likely that some visits that involved antidepressant management were actually coded without mental illness diagnoses, and this is the first study to address this issue in sensitivity analyses. Our data allowed us to identify visits made to the same provider who wrote the initial antidepressant prescription, which provided an opportunity for patients to talk about antidepressant treatment, although it might not be the main reason for the visit. Results from the sensitivity analyses that accounted for these types of visits still found that initiating antidepressant treatment with a psychiatrist was associated with greater odds of receipt of guideline-concordant follow-up visits. This sensitivity analysis provides greater confidence that there is a systematic difference between primary care providers and psychiatrists who initiate antidepressant treatment. Our study has several limitations. The study was based on a commercially insured population. We also included a continuously enrolled population, who might be more stable in the plan and have a greater likelihood of having guideline-concordant follow-up visits. Therefore, the results might not generalize to the publicly insured population. The study utilized data before the black-box warning for antidepressants, and practice patterns might have changed after this warning was implemented. Many plan-specific variables (for example, benefit structure) and provider-specific variables (for example, years of practice, practice setting, and patient volume) were not available in the data, which may explain variation in follow-up rates between provider specialties. Unobservable confounders may exist. Finally, the observational design prohibits attribution of causality. Our study highlights the existence of suboptimal care and differences between provider specialties. Followup visits are likely driven by both providers and patients. Future research should systematically evaluate the differences in attitudes toward, knowledge of, and barriers to depression care between mental health specialists and primary care providers. Studies should also examine how patient behavioral factors (such as attitude, knowledge, and stigma) and clinical factors (such as depression severity) may affect patient demand for follow-up visits. These studies could assist policy makers in understanding how to support primary care to provide more guideline-concordant care to patients with depression and to simulate effective organizational intervention to improve quality of care. Finally, future research should focus on linking follow-up visits to patient outcome, such as antidepressant response, to understand their effectiveness over managing antidepressant therapy. Conclusions Our findings suggest that only a small proportion of patients initiating antidepressant treatment for major depressive disorder received guideline-concordant follow-up visits. Large differences were found between primary care and mental health specialty settings in follow-up visits, but reasons for such differences require further investigation. There is still much room for improvement if primary care settings are to be the preferred location for depression treatment. 84 PSYCHIATRIC SERVICES ps.psychiatryonline.org January 2010 Vol. 61 No. 1

5 Acknowledgments and disclosures Dr. Chen is employed by Abt Bio-Pharma Solutions. Dr. Hansen has received consulting fees from Takeda Pharmaceuticals. Dr. Farley has received grant funding from the Pfizer Foundation and consulting fees from Takeda Pharmaceuticals. Dr. Gaynes has received grants and research support from M-3 Information, Bristol-Myers Squibb, and Novartis, and he has served as an advisor for Bristol-Myers Squibb. The other authors report no competing interests. References 1. Luppa M, Heinrich S, Angermeyer MC, et al: Cost-of-illness studies of depression: a systematic review. Journal of Affective Disorders 98:29 43, Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd ed. Arlington, Va, American Psychiatric Association, Qaseem A, Snow V, Denberg TD, et al: Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 149: , Depression in Primary Care: Vol 2: Treatment of Major Depression. Clinical Practice Guideline, 5. Rockville, Md, Agency for Health Care Policy and Research, Young AS, Klap R, Sherbourne CD, et al: The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry 58:55 61, Jones LE, Turvey C, Carney-Doebbeling C: Inadequate follow-up care for depression and its impact on antidepressant treatment duration among veterans with and without diabetes mellitus in the Veterans Health Administration. General Hospital Psychiatry 28: , Robinson RL, Long SR, Chang S, et al: Higher costs and therapeutic factors associated with adherence to NCQA HEDIS antidepressant medication management measures: analysis of administrative claims. Journal of Managed Care Pharmacy 12:43 54, Simon GE, Von Korff M, Rutter CM, et al: Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Archives of General Psychiatry 58: , HEDIS 2006: Healthcare Effectiveness Data and Information Set: Vol 2. Technical Specifications. Washington, DC, National Committee for Quality Assurance, Clark DO, Von Korff M, Saunders K, et al: A chronic disease score with empirically derived weights. Medical Care 33: , Parsons LS: Reducing bias in a propensity score matched pair sample using greedy matching techniques. Presented at SAS Users Group International Proceedings, Montréal, Canada, May 9 12, Available at www2.sas.com/proceedings/sugi 26/p pdf 12. Davidson JR, Meltzer-Brody SE: The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? Journal of Clinical Psychiatry 60:4 9, Trivedi MH, Lin EH, Katon WJ: Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression. CNS Spectrums 12:1 27, Nutting PA, Rost K, Dickinson M, et al: Barriers to initiating depression treatment in primary care practice. Journal of General Internal Medicine 17: , Gaynes BN, Rush AJ, Trivedi MH, et al: Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR D. Journal of General Internal Medicine 23: , 2008 Submissions for Datapoints Column Invited Submissions to the journal s Datapoints column are invited. Datapoints encourages the rapid dissemination of relevant and timely findings related to clinical and policy issues in psychiatry. National data are preferred. Areas of interest include diagnosis and practice patterns, treatment modalities, treatment sites, patient characteristics, and payment sources. The analyses should be straightforward, so that the figure or figures tell the story. The text should follow the standard research format to include a brief introduction, description of the methods and data set, description of the results, and comments on the implications or meanings of the findings. Datapoints columns, which have a one-page format, are typically 350 to 400 words of text with one or two figures. Because of space constraints, submissions with multiple authors are discouraged; submissions with more than four authors should include justification for additional authors. Inquiries or submissions should be directed to column editors Amy M. Kilbourne, Ph.D., M.P.H. (amy.kilbourne@va.gov), or Tami L. Mark, Ph.D. (tami. mark@thomsonreuters.com). PSYCHIATRIC SERVICES ps.psychiatryonline.org January 2010 Vol. 61 No. 1 85

SECOND-GENERATION ANTIDEPRESSANT USE IN TREATMENT FOR MAJOR DEPRESSIVE DISORDER-AN EXAMINATION OF GUIDELINE COMPONENTS AND HEALTHCARE UTILIZATION

SECOND-GENERATION ANTIDEPRESSANT USE IN TREATMENT FOR MAJOR DEPRESSIVE DISORDER-AN EXAMINATION OF GUIDELINE COMPONENTS AND HEALTHCARE UTILIZATION SECOND-GENERATION ANTIDEPRESSANT USE IN TREATMENT FOR MAJOR DEPRESSIVE DISORDER-AN EXAMINATION OF GUIDELINE COMPONENTS AND HEALTHCARE UTILIZATION Shih-Yin Chen A dissertation submitted to the faculty of

More information

A Retrospective Claims Analysis of Medication Adherence and. Persistence Among Patients Taking Antidepressants

A Retrospective Claims Analysis of Medication Adherence and. Persistence Among Patients Taking Antidepressants A Retrospective Claims Analysis of Medication Adherence and Persistence Among Patients Taking Antidepressants for the Treatment of Major Depressive Disorder (MDD) Katelyn R. Keyloun A thesis submitted

More information

Psychiatry in a Collaborative System-Level and Practice-Level

Psychiatry in a Collaborative System-Level and Practice-Level Psychiatry in a Collaborative System-Level and Practice-Level Robin M. Reed, MD, MPH Presentation for the North Carolina Psychiatric Association October 2 nd 2015 Disclosures I have no relevant financial

More information

Jae Jin An, Ph.D. Michael B. Nichol, Ph.D.

Jae Jin An, Ph.D. Michael B. Nichol, Ph.D. IMPACT OF MULTIPLE MEDICATION COMPLIANCE ON CARDIOVASCULAR OUTCOMES IN PATIENTS WITH TYPE II DIABETES AND COMORBID HYPERTENSION CONTROLLING FOR ENDOGENEITY BIAS Jae Jin An, Ph.D. Michael B. Nichol, Ph.D.

More information

Depressive disorders are common in primary care,

Depressive disorders are common in primary care, Do Clinician and Patient Adherence Predict Outcome in a Depression Disease Management Program? Catherine J. Datto, MD, Richard Thompson, PhD, David Horowitz, MD, Maureen Disbot, RN, Hillary Bogner, MD,

More information

METHODS RESULTS. Supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC

METHODS RESULTS. Supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC PREDICTORS OF MEDICATION ADHERENCE AMONG PATIENTS WITH SCHIZOPHRENIC DISORDERS TREATED WITH TYPICAL AND ATYPICAL ANTIPSYCHOTICS IN A LARGE STATE MEDICAID PROGRAM S.P. Lee 1 ; K. Lang 2 ; J. Jackel 2 ;

More information

A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY. Helen Mari Parsons

A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY. Helen Mari Parsons A Culture of Quality? Lymph Node Evaluation for Colon Cancer Care A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Helen Mari Parsons IN PARTIAL FULFILLMENT

More information

Zhao Y Y et al. Ann Intern Med 2012;156:

Zhao Y Y et al. Ann Intern Med 2012;156: Zhao Y Y et al. Ann Intern Med 2012;156:560-569 Introduction Fibrates are commonly prescribed to treat dyslipidemia An increase in serum creatinine level after use has been observed in randomized, placebocontrolled

More information

Reliable and reproducible effect size estimates at scale

Reliable and reproducible effect size estimates at scale Reliable and reproducible effect size estimates at scale Marc A. Suchard, M.D., Ph.D. Departments of Biomathematics and Human Genetics David Geffen School of Medicine at UCLA, and Department of Biostatistics

More information

care physicians (4 8). As a result, government agencies, accrediting organizations for example, the National Committee for Quality Assurance and

care physicians (4 8). As a result, government agencies, accrediting organizations for example, the National Committee for Quality Assurance and Aligning Incentives in the Treatment of Depression in Primary Care With Evidence-Based Practice Richard G. Frank, Ph.D. Haiden A. Huskamp, Ph.D. Harold Alan Pincus, M.D. Deficits in the quality of treatment

More information

Clinical Policy Title: Ketamine for treatment-resistant depression

Clinical Policy Title: Ketamine for treatment-resistant depression Clinical Policy Title: Ketamine for treatment-resistant depression Clinical Policy Number: 00.02.13 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: January

More information

Depression affects between 32.6 and 35.1 million adults

Depression affects between 32.6 and 35.1 million adults ORIGINAL RESEARCH Relationship of Total Health Care Charges to Selective Serotonin Reuptake Inhibitor Utilization Patterns Including the Length of Antidepressant Therapy Results From a Managed Care Administrative

More information

Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications

Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications MWSUG 2017 - Paper DG02 Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications ABSTRACT Deanna Naomi Schreiber-Gregory, Henry M Jackson

More information

The Association Between Rural Residence and the Use, Type, and Quality of Depression Care

The Association Between Rural Residence and the Use, Type, and Quality of Depression Care The Association Between Rural Residence and the Use, Type, and Quality of Depression Care John C. Fortney 1,2,3 Jeffrey S. Harman 4 Stanley Xu 5 Fran Dong 6 1. South Central Mental Illness Education and

More information

Measurement-based Scales in Major Depressive Disorder:

Measurement-based Scales in Major Depressive Disorder: This program is paid for by Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck, LLC. The speaker is a paid contractor of Otsuka Pharmaceutical Development and Commercialization, Inc.

More information

Supplementary figures and tables. Figure A: Study schematic

Supplementary figures and tables. Figure A: Study schematic Supplementary figures and tables Figure A: Study schematic Figure B: Percent of patients with a normal (green), borderline (beige), abnormal (brown), or high (red) electrocardiogram 14-90 days after prescription

More information

Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care

Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care CLINICAL ASSESSMENT AND DIAGNOSIS (ADULTS) Obsessive-Compulsive Disorder (OCD) is categorized by recurrent obsessions,

More information

Adequacy of antidepressant

Adequacy of antidepressant Course of Antidepressant Treatment, Drug Type, and Prescriber s Specialty Kathleen A. Fairman, M.A. Wayne C. Drevets, M.D. Jerold J. Kreisman, M.D. Fred Teitelbaum, Ph.D. Objective: The study examined

More information

Depression is a highly prevalent condition that results in

Depression is a highly prevalent condition that results in ORIGINAL ARTICLE Effects of Pharmaceutical Promotion on Adherence to the Treatment Guidelines for Depression Julie M. Donohue, PhD,* Ernst R. Berndt, PhD, Meredith Rosenthal, PhD, Arnold M. Epstein, MD,

More information

This article presents results

This article presents results An Empirical Analysis of Cost Outcomes of the Texas Medication Algorithm Project T. Michael Kashner, Ph.D., J.D. A. John Rush, M.D. M. Lynn Crismon, Pharm.D. Marcia Toprac, Ph.D. Thomas J. Carmody, Ph.D.

More information

Erik Muser, Pharm.D.

Erik Muser, Pharm.D. Opportunities for Improving Health Plan Performance on HEDIS Measures for Follow-up Visits among Children Prescribed ADHD Medications By Erik Muser, Pharm.D. A Master s Paper submitted to the faculty of

More information

Performance Measurement

Performance Measurement Performance Measurement Diagnosis and Treatment of Depression: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing Committee Amir Qaseem,

More information

Age of Depressed Patient Does Not Affect Clinical Outcome in Collaborative Care Management

Age of Depressed Patient Does Not Affect Clinical Outcome in Collaborative Care Management CLINICAL FOCUS: ADHD, DEPRESSION, PAIN, AND NEUROLOGICAL DISORDERS Age of Depressed Patient Does Not Affect Clinical Outcome in Collaborative Care Management DOI: 10.3810/pgm.2011.09.2467 Kurt B. Angstman,

More information

MANAGERIAL. Frequency of Follow-up Care for Adult and Pediatric Patients During Initiation of Antidepressant Therapy

MANAGERIAL. Frequency of Follow-up Care for Adult and Pediatric Patients During Initiation of Antidepressant Therapy Frequency of Follow-up Care for Adult and Pediatric Patients During Initiation of Antidepressant Therapy Glen D. Stettin, MD; Jianying Yao, MS; Robert R. Verbrugge, PhD; and Ronald E. Aubert, PhD Objectives:

More information

Integrating Care for the Whole Person: Collaborative Teams for Behavioral Health and Medical Conditions

Integrating Care for the Whole Person: Collaborative Teams for Behavioral Health and Medical Conditions Integrating Care for the Whole Person: Collaborative Teams for Behavioral Health and Medical Conditions February 16, 2016 Presented by Dr. Paul Ciechanowski 2/25/2017 1 Opening Remarks Purpose Welcoming

More information

Mental health planners and policymakers routinely rely on utilization

Mental health planners and policymakers routinely rely on utilization DataWatch Measuring Outpatient Mental Health Care In The United States by Mark Olfson and Harold Alan Pincus Abstract: A standard definition of outpatient mental health care does not now exist. Data from

More information

The dramatic growth of managed. Use of Psychiatrists, Psychologists, and Master s-level Therapists in Managed Behavioral Health Care Carve-Out Plans

The dramatic growth of managed. Use of Psychiatrists, Psychologists, and Master s-level Therapists in Managed Behavioral Health Care Carve-Out Plans Use of Psychiatrists, Psychologists, and Master s-level Therapists in Managed Behavioral Health Care Carve-Out Plans Roland Sturm, Ph.D. Ruth Klap, Ph.D. Objective: Outpatient claims data from a managed

More information

Treating Depression in Disadvantaged Women: What is the evidence?

Treating Depression in Disadvantaged Women: What is the evidence? Treating Depression in Disadvantaged Women: What is the evidence? Megan Dwight Johnson, MD MPH Associate Professor Medical Director, UWMC Inpatient Psychiatry Department of Psychiatry and Behavioral Sciences

More information

December 2014 MRC2.CORP.D.00011

December 2014 MRC2.CORP.D.00011 This program is paid for by Otsuka America Pharmaceutical, Inc. and Lundbeck, LLC. The speaker is a paid contractor of Otsuka America Pharmaceutical, Inc. advice or professional diagnosis. Users seeking

More information

The Pennsylvania State University. The Graduate School. Department of Public Health Sciences

The Pennsylvania State University. The Graduate School. Department of Public Health Sciences The Pennsylvania State University The Graduate School Department of Public Health Sciences THE IMPACT OF THE AFFORDABLE CARE ACT ON CONTRACEPTIVE USE AND COSTS AMONG PRIVATELY INSURED WOMEN A Thesis in

More information

Employers, in their role as health care purchasers, are

Employers, in their role as health care purchasers, are Article Health and Disability Costs of Depressive Illness in a Major U.S. Corporation Benjamin G. Druss, M.D., M.P.H. Robert A. Rosenheck, M.D. William H. Sledge, M.D. Objective: Employers are playing

More information

Quality of guideline-concordant care and treatment for depression in the Veterans Health Administration and its impact on glycemic control

Quality of guideline-concordant care and treatment for depression in the Veterans Health Administration and its impact on glycemic control University of Iowa Iowa Research Online Theses and Dissertations 2006 Quality of guideline-concordant care and treatment for depression in the Veterans Health Administration and its impact on glycemic

More information

Reduction of Patient-Reported Antidepressant Side Effects, by Type of Collaborative Care

Reduction of Patient-Reported Antidepressant Side Effects, by Type of Collaborative Care ARTICLES This article addresses the Core Competency of Practice-Based Learning and Improvement Reduction of Patient-Reported Antidepressant Side Effects, by Type of Collaborative Care Teresa J. Hudson,

More information

In 2003, the Food and Drug Administration (FDA)

In 2003, the Food and Drug Administration (FDA) Who Receives Outpatient Monitoring During High-Risk Depression Treatment Periods? Helen C. Kales, MD, w H. Myra Kim, ScD, z Karen L. Austin, MPH, and Marcia Valenstein, MD, MS w OBJECTIVES: To examine

More information

Phase 2 Measures of Depression Population

Phase 2 Measures of Depression Population Phase 2 Measures of Depression Population Each Phase 2 depression team is required to track and report the core national measures (measures 1 through 4) along with the count of patients with depression

More information

Schizophrenia, a devastating chronic. Treatment Adherence Associated With Conventional and Atypical Antipsychotics in a Large State Medicaid Program

Schizophrenia, a devastating chronic. Treatment Adherence Associated With Conventional and Atypical Antipsychotics in a Large State Medicaid Program Treatment Adherence Associated With Conventional and Atypical Antipsychotics in a Large State Medicaid Program Joseph Menzin, Ph.D. Luke Boulanger, M.A. Mark Friedman, M.D. Joan Mackell, Ph.D. John R.

More information

Implementing and Improving Depression Screenings in the Primary Care Setting. Janet Tennison, PhD, MSW, LCSW Behavioral Health Project Manager

Implementing and Improving Depression Screenings in the Primary Care Setting. Janet Tennison, PhD, MSW, LCSW Behavioral Health Project Manager Implementing and Improving Depression Screenings in the Primary Care Setting Janet Tennison, PhD, MSW, LCSW Behavioral Health Project Manager Today s Objectives Participants will: Increase understanding

More information

Poor adherence with antipsychotic

Poor adherence with antipsychotic Assertive Community Treatment in Veterans Affairs Settings: Impact on Adherence to Antipsychotic Medication Marcia Valenstein, M.D., M.S. John F. McCarthy, Ph.D. Dara Ganoczy, M.P.H. Nicholas W. Bowersox,

More information

Adherence to therapy. Kamlesh Khunti University of Leicester, UK. William Polonsky University of California San Diego, USA

Adherence to therapy. Kamlesh Khunti University of Leicester, UK. William Polonsky University of California San Diego, USA Adherence to therapy Kamlesh Khunti University of Leicester, UK William Polonsky University of California San Diego, USA 1 Dualities of interest Kamlesh Khunti: Honoraria for speaking, advising or research

More information

Mood Disorders Society of Canada Mental Health Care System Study Summary Report

Mood Disorders Society of Canada Mental Health Care System Study Summary Report Mood Disorders Society of Canada Mental Health Care System Study Summary Report July 2015 Prepared for the Mood Disorders Society of Canada by: Objectives and Methodology 2 The primary objective of the

More information

2) Percentage of adult patients (aged 18 years or older) with a diagnosis of major depression or dysthymia and an

2) Percentage of adult patients (aged 18 years or older) with a diagnosis of major depression or dysthymia and an Quality ID #370 (NQF 0710): Depression Remission at Twelve Months National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Prevention, Treatment, and Management of Mental Health

More information

Supplementary Methods

Supplementary Methods Supplementary Materials for Suicidal Behavior During Lithium and Valproate Medication: A Withinindividual Eight Year Prospective Study of 50,000 Patients With Bipolar Disorder Supplementary Methods We

More information

Long-Term Effects on Medical Costs of Improving Depression Outcomes in Patients With Depression and Diabetes

Long-Term Effects on Medical Costs of Improving Depression Outcomes in Patients With Depression and Diabetes Epidemiology/Health Services Research O R I G I N A L A R T I C L E Long-Term Effects on Medical Costs of Improving Depression Outcomes in Patients With Depression and Diabetes WAYNE J. KATON, MD 1 JOAN

More information

Table 2. Distribution of Normalized Inverse Probability of Treatment Weights. Healthcare costs (US $2012) Notes:

Table 2. Distribution of Normalized Inverse Probability of Treatment Weights. Healthcare costs (US $2012) Notes: 228 COMPARISON OF HEALTHCARE RESOURCE UTILIZATION AND MEDICAID SPENDING AMONG PATIENTS WITH SCHIZOPHRENIA TREATED WITH ONCE MONTHLY PALIPERIDONE PALMITATE OR ORAL ATYPICAL ANTIPSYCHOTICS USING THE INVERSE

More information

Making an IMPACT on late-life depression. Partnering with primary care providers can double the effect of treatment

Making an IMPACT on late-life depression. Partnering with primary care providers can double the effect of treatment University of Massachusetts Boston From the SelectedWorks of Steven D Vannoy Fall September, 2006 Making an IMPACT on late-life depression. Partnering with primary care providers can double the effect

More information

Major Depressive Disorder (MDD) in Children under Age 6

Major Depressive Disorder (MDD) in Children under Age 6 in Children under Age 6 Level 0 Comprehensive assessment. Refer to Principles of Practice on page 5. Level 1 Psychotherapeutic intervention (e.g., dyadic therapy) for 6 to 9 months; assessment of parent/guardian

More information

Mosaic approach for monitoring Healthy People 2020 objectives:

Mosaic approach for monitoring Healthy People 2020 objectives: Mosaic approach for monitoring Healthy People 2020 objectives: A substance abuse surveillance system Karilynn Rockhill 1, Gabrielle E. Bau 1, Matthew S. Ellis 2, Theodore J. Cicero 2, Richard Dart 1 1

More information

The STOP Measure. Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse FEBRUARY 2018

The STOP Measure. Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse FEBRUARY 2018 The STOP Measure Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse FEBRUARY 2018 AHIP s Safe, Transparent Opioid Prescribing (STOP) Initiative Methodology

More information

The American healthcare system, particularly the managed

The American healthcare system, particularly the managed REPORTS Collaborative Care and Motivational Interviewing: Improving Depression Outcomes Through Patient Empowerment Interventions Bill Anderson, PharmD The American healthcare system, particularly the

More information

New England healthcare providers perceptions, knowledge and practices regarding the use of antiretrovirals for prevention

New England healthcare providers perceptions, knowledge and practices regarding the use of antiretrovirals for prevention New England healthcare providers perceptions, knowledge and practices regarding the use of antiretrovirals for prevention Douglas Krakower, Catherine Oldenburg, Jennifer Mitty, Ira Wilson, Ann Kurth, Kevin

More information

Questionnaire on Anticipated Discrimination (QUAD)(1): is a self-complete measure comprising 14 items

Questionnaire on Anticipated Discrimination (QUAD)(1): is a self-complete measure comprising 14 items Online Supplement Data Supplement for Clement et al. (10.1176/appi.ps.201300448) Details of additional measures included in the analysis Questionnaire on Anticipated Discrimination (QUAD)(1): is a self-complete

More information

Apurba Chakraborty MBBS, MPH Dima M. Qato PharmD, MPH, PhD Professor Mark S. Dworkin MD, MPHTM The University of Illinois at Chicago

Apurba Chakraborty MBBS, MPH Dima M. Qato PharmD, MPH, PhD Professor Mark S. Dworkin MD, MPHTM The University of Illinois at Chicago Less is More: The Impact of Lower Pill Burden on Adherence to Antiretroviral Therapy among Treatment-Naive Patients with HIV Infection in the United States Apurba Chakraborty MBBS, MPH Dima M. Qato PharmD,

More information

Engagement in Outpatient Care for Patients Living with HIV (PLWH)

Engagement in Outpatient Care for Patients Living with HIV (PLWH) Engagement in Outpatient Care for Patients Living with HIV (PLWH) Christine Oramasionwu 1, Stacy Cooper Bailey 1, Terence Johnson 1, Lu Mao 2 1 UNC Eshelman School of Pharmacy, University of North Carolina,

More information

Table 1 Results of the 12-item General Health Questionnaire among caregivers who were or were not evacuated Not evacuated (N=46)

Table 1 Results of the 12-item General Health Questionnaire among caregivers who were or were not evacuated Not evacuated (N=46) Table 1 Results of the 12-item General Health Questionnaire among caregivers who were or were not evacuated Not evacuated (N=46) Evacuated (N=46) Item N % N % 2a p Unable to concentrate 4 4 20 22 14.4

More information

Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database

Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database open access Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database Carol Coupland, 1 Trevor Hill, 1 Richard Morriss, 2 Michael Moore, 3

More information

9/16/2016. I would feel comfortable dispensing/prescribing varenicline to a patient with a mental health disorder. Learning Objectives

9/16/2016. I would feel comfortable dispensing/prescribing varenicline to a patient with a mental health disorder. Learning Objectives The Smoking Gun: for Smoking Cessation in Patients with Mental Health Disorders BRENDON HOGAN, PHARMD PGY2 PSYCHIATRIC PHARMACY RESIDENT CTVHCS, TEMPLE, TX 09/23/2016 I would feel comfortable dispensing/prescribing

More information

Designing an Electronic Medical Record-based Clinical Decision Support Tool to Improve CVD Screening in Rheumatoid Arthritis Patients

Designing an Electronic Medical Record-based Clinical Decision Support Tool to Improve CVD Screening in Rheumatoid Arthritis Patients Designing an Electronic Medical Record-based Clinical Decision Support Tool to Improve CVD Screening in Rheumatoid Arthritis Patients Provided and Certified By Grant Award # 045604 Report Date: March 29,

More information

The Supply and Distribution of Psychiatrists in North Carolina: Pressing Issues in the Context of Mental Health Reform

The Supply and Distribution of Psychiatrists in North Carolina: Pressing Issues in the Context of Mental Health Reform This project is a collaboration between the North Carolina Area Health Education Centers (NC AHEC) Program, the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine and

More information

Seamless: Integrating behavioral health and primary care

Seamless: Integrating behavioral health and primary care Seamless: Integrating behavioral health and primary care Benjamin F. Miller, PsyD Director of the Office of Integrated Healthcare Research and Policy Department of Family Medicine University of Colorado

More information

HEALTH CARE EXPENDITURES ASSOCIATED WITH PERSISTENT EMERGENCY DEPARTMENT USE: A MULTI-STATE ANALYSIS OF MEDICAID BENEFICIARIES

HEALTH CARE EXPENDITURES ASSOCIATED WITH PERSISTENT EMERGENCY DEPARTMENT USE: A MULTI-STATE ANALYSIS OF MEDICAID BENEFICIARIES HEALTH CARE EXPENDITURES ASSOCIATED WITH PERSISTENT EMERGENCY DEPARTMENT USE: A MULTI-STATE ANALYSIS OF MEDICAID BENEFICIARIES Presented by Parul Agarwal, PhD MPH 1,2 Thomas K Bias, PhD 3 Usha Sambamoorthi,

More information

Major Depressive Disorder (MDD) in Children under Age 6

Major Depressive Disorder (MDD) in Children under Age 6 in Children under Age 6 Level 0 Comprehensive assessment. Refer to Principles of Practice on page 6. Level 1 Psychotherapeutic intervention (e.g., dyadic therapy) for 6 to 9 months; assessment of parent/guardian

More information

than threefold increase in spending in that period (6). The increase in advertising of antidepressant medications

than threefold increase in spending in that period (6). The increase in advertising of antidepressant medications Changing Perceptions of Depression: Ten- Year Trends From the General Social Survey Kate H. Blumner, M.D., M.P.H. Steven C. Marcus, Ph.D. Objective: The authors examined the changes in beliefs about the

More information

Mental Health Series for Perinatal Prescribers. Pharmacotherapy for depression and anxiety

Mental Health Series for Perinatal Prescribers. Pharmacotherapy for depression and anxiety Mental Health Series for Perinatal Prescribers Pharmacotherapy for depression and anxiety Non-medication Treatments Psychosocial support Prenatal education, Doula support, La Leche League, Mom s groups,

More information

RESEARCH. What is already known about this subject

RESEARCH. What is already known about this subject RESEARCH Comparative Treatment Patterns, Resource Utilization, and Costs in Stimulant-Treated Children with ADHD Who Require Subsequent Pharmacotherapy with Atypical Antipsychotics Versus Non-Antipsychotics

More information

Exhibit I-1 Performance Measures. Numerator (general description only)

Exhibit I-1 Performance Measures. Numerator (general description only) # Priority Type Performance Measure Core Measures (implement 9/1/09) 1 C OE Hospital readmissions within 7, 30 and 90 days postdischarge 2 C OE Percent of Members prescribed redundant or duplicated antipsychotic

More information

DIABETES ASSOCIATED WITH ANTIPSYCHOTIC USE IN VETERANS WITH SCHIZOPHRENIA

DIABETES ASSOCIATED WITH ANTIPSYCHOTIC USE IN VETERANS WITH SCHIZOPHRENIA DIABETES ASSOCIATED WITH ANTIPSYCHOTIC USE IN VETERANS WITH SCHIZOPHRENIA Fran Cunningham, Pharm.D. Department of Veterans Affairs* University of Illinois at Chicago Bruce Lambert, Ph.D. University of

More information

Consensus standards for evidence-based

Consensus standards for evidence-based Pharmacotherapy of Alcohol Use Disorders by the Veterans Health Administration: Patterns of Receipt and Persistence Alex H. S. Harris, Ph.D., M.S. Elizabeth Oliva, Ph.D. Thomas Bowe, Ph.D. Keith N. Humphreys,

More information

Facilitating Cross-System Data Sharing for Psychotropic Medication Oversight and Monitoring

Facilitating Cross-System Data Sharing for Psychotropic Medication Oversight and Monitoring Improving the quality and cost-effectiveness of publicly financed health care Facilitating Cross-System Data Sharing for Psychotropic Medication Oversight and Monitoring Psychotropic Medication Use Among

More information

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST DECLARATION OF CONFLICT OF INTEREST Warfarin and the risk of major bleeding events in patients with atrial fibrillation: a population-based study Laurent Azoulay PhD 1,2, Sophie Dell Aniello MSc 1, Teresa

More information

This article addresses the Core Competency of Systems-Based Practice

This article addresses the Core Competency of Systems-Based Practice This article addresses the Core Competency of Systems-Based Practice ARTICLES Enrollment and Service Use Patterns Among Persons With Severe Mental Illness Receiving Expedited Medicaid on Release From State

More information

Chapter 2: Identification and Care of Patients With CKD

Chapter 2: Identification and Care of Patients With CKD Chapter 2: Identification and Care of Patients With CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease

More information

had non-continuous enrolment in Medicare Part A or Part B during the year following initial admission;

had non-continuous enrolment in Medicare Part A or Part B during the year following initial admission; Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among Medicare beneficiaries Weiss J P, Saynina O, McDonald K M, McClellan M

More information

Identifying and evaluating patterns of prescription opioid use and associated risks in Ontario, Canada Gomes, T.

Identifying and evaluating patterns of prescription opioid use and associated risks in Ontario, Canada Gomes, T. UvA-DARE (Digital Academic Repository) Identifying and evaluating patterns of prescription opioid use and associated risks in Ontario, Canada Gomes, T. Link to publication Citation for published version

More information

ANTIDEPRESSANT MEDICATION & RISK OF DEMENTIA

ANTIDEPRESSANT MEDICATION & RISK OF DEMENTIA ANTIDEPRESSANT MEDICATION & RISK OF DEMENTIA A Nationwide Cohort Study in Taiwan / Speaker: Chee-Kin Then / Advisor: Prof. Shing-Chuan Shen / Unit: Graduate Institute of Medical Sciences / Date: 2017.04.

More information

GSK Medicine: Study Number: Title: Rationale: Study Period: Objectives: Indication: Study Investigators/Centers: Research Methods: Data Source

GSK Medicine: Study Number: Title: Rationale: Study Period: Objectives: Indication: Study Investigators/Centers: Research Methods: Data Source The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.

More information

Antidepressant medications are. Antidepressant Switching Among Adherent Patients Treated for Depression

Antidepressant medications are. Antidepressant Switching Among Adherent Patients Treated for Depression Antidepressant Switching Among Adherent Patients Treated for Depression Steven C. Marcus, Ph.D. Mariam Hassan, Ph.D. Mark Olfson, M.D., M.P.H. Objective: This study examined the pharmacologic, clinical,

More information

VA physicians usually do not detect and treat substance use disorders within the primary care setting

VA physicians usually do not detect and treat substance use disorders within the primary care setting VA physicians usually do not detect and treat substance use disorders within the primary care setting Evaluation report to the VA Mental Health Strategic Healthcare Group VA Central Office, Washington,

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Callaghan B, McCammon R, Kerber K, Xu X, Langa KM, Feldman E. Tests and expenditures in the initial evaluation of peripheral neuropathy. Arch Intern Med. 2012;172(2):127-132.

More information

TYPE IN THE CHAT. Please type your name, organization, and city/state into the chat.

TYPE IN THE CHAT. Please type your name, organization, and city/state into the chat. TYPE IN THE CHAT Please type your name, organization, and city/state into the chat. 1 EDC. 2017 All Rights Reserved. Data-Driven Quality Improvement in Zero Suicide May 2, 2017 2 Funding and Disclaimer

More information

Treating Patients with Depression Using Coordinated Medication Management. November 13, 2018

Treating Patients with Depression Using Coordinated Medication Management. November 13, 2018 Treating Patients with Depression Using Coordinated Medication Management November 13, 2018 Learning objectives Good Afternoon! Elisabeth Hager, MD, MMM Chief Medical Officer Southeast/Central Region 1)

More information

Effective Health Care

Effective Health Care Number 7 Effective Health Care Comparative Effectiveness of Second- Generation Antidepressants in the Pharmacologic Treatment of Adult Depression Executive Summary Background Depressive disorders such

More information

Errata. After Publication, we found a few errors in Figures and text from How Are Manitoba s Children Doing?.

Errata. After Publication, we found a few errors in Figures and text from How Are Manitoba s Children Doing?. Errata After Publication, we found a few errors in Figures and text from How Are Manitoba s Children Doing?. The distribution of neighbourhood average income quintile ranges in Manitoba, Winnipeg, and

More information

ANTIDEPRESSANT MEDICATION USE AMONG FIRST NATIONS PEOPLES RESIDING WITHIN BRITISH COLUMBIA

ANTIDEPRESSANT MEDICATION USE AMONG FIRST NATIONS PEOPLES RESIDING WITHIN BRITISH COLUMBIA ANTIDEPRESSANT MEDICATION USE AMONG FIRST NATIONS PEOPLES RESIDING WITHIN BRITISH COLUMBIA Dennis Wardman, M.D. and Nadia Khan, M.D. Abstract: Very little is known about antidepressant medication use among

More information

Life Goals Collaborative Care

Life Goals Collaborative Care Brief Reports Life Goals Collaborative Care for Patients With Bipolar Disorder and Cardiovascular Disease Risk Amy M. Kilbourne, M.D., M.P.H. David E. Goodrich, Ed.D. Zongshan Lai, M.S., M.P.H. Julia Clogston,

More information

Gynecologic Visit Rates for Medicaid Enrollees with Mental and Substance Use Disorders

Gynecologic Visit Rates for Medicaid Enrollees with Mental and Substance Use Disorders Cervical Cancer Screening and Gynecologic Visit Rates for Medicaid Enrollees with Mental and Substance Use Disorders November 10, 2010 Michael T. Abrams, MPH, Susan Chen, MBA, & Cynthia Boddie-Willis,

More information

Clinical Practice Guideline for PTSD: An Overview of the Process and the Product Featuring APA Staff Psychologist Lynn Bufka, PhD

Clinical Practice Guideline for PTSD: An Overview of the Process and the Product Featuring APA Staff Psychologist Lynn Bufka, PhD APA Webinar Clinical Practice Guideline for PTSD: An Overview of the Process and the Product Featuring APA Staff Psychologist Lynn Bufka, PhD December 12, 2017 THE WEBINAR WILL BEGIN MOMENTARILY AMERICAN

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Pincus D, Ravi B, Wasserstein D. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. doi: 10.1001/jama.2017.17606 eappendix

More information

Antidepressant Use and Depressive Symptoms in Intensive Care Unit Survivors

Antidepressant Use and Depressive Symptoms in Intensive Care Unit Survivors Antidepressant Use in ICU Survivors 1 Antidepressant Use and Depressive Symptoms in Intensive Care Unit Survivors Sophia Wang, MD, Chris Mosher, MD, Sujuan Gao, PhD, Kayla Kirk, MA, Sue Lasiter, PhD, RN,

More information

Hae Sun Suh, B.Pharm., Ph.D. Jason N. Doctor, Ph.D.

Hae Sun Suh, B.Pharm., Ph.D. Jason N. Doctor, Ph.D. Podium Presentation, May 18, 2009 Comparison of Cardiovascular Event Rates in Subjects with Type II Diabetes Mellitus who Augmented from Statin Monotherapy to Statin Plus Fibrate Combination Therapy with

More information

Post-market Authorized Generic Evaluation (PAGE)

Post-market Authorized Generic Evaluation (PAGE) Post-market Authorized Generic Evaluation (PAGE) U01FD005272-02 November 18 th, 2016 Peggy L. Peissig Richard Berg Michael Caldwell James Linneman Richard Hansen Jingjing Qian Motiur Rahman Ning Cheng

More information

Racial Variation In Quality Of Care Among Medicare+Choice Enrollees

Racial Variation In Quality Of Care Among Medicare+Choice Enrollees Racial Variation In Quality Of Care Among Medicare+Choice Enrollees Black/white patterns of racial disparities in health care do not necessarily apply to Asians, Hispanics, and Native Americans. by Beth

More information

Attn: Alicia Richmond Scott, Pain Management Task Force Designated Federal Officer

Attn: Alicia Richmond Scott, Pain Management Task Force Designated Federal Officer March 18, 2019 Office of the Assistant Secretary of Health U.S. Department of Health and Human Services 200 Independence Avenue SW, Room 736E Washington, DC 20201 Attn: Alicia Richmond Scott, Pain Management

More information

Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC)

Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC) Community Mental Health Journal, Vol. 39, No. 6, December 2003 ( 2003) Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC) Mona Goldman,

More information

Depression in Chronic Physical Health Problems FULL GUIDELINE 1

Depression in Chronic Physical Health Problems FULL GUIDELINE 1 O Connor 2005 U.S.A. Sertraline Placebo Study design data source Patients who were hospitalised for acute coronary syndromes and who met the APA s DSMIV criteria for major depressive disorder (MDD). :

More information

CENTER OF EXCELLENCE MATERNAL AND CHILD MENTAL HEALTH (MCMH)

CENTER OF EXCELLENCE MATERNAL AND CHILD MENTAL HEALTH (MCMH) CENTER OF EXCELLENCE MATERNAL AND CHILD MENTAL HEALTH (MCMH) The infant and young child should experience a warm, intimate, and continuous relationship with his mother in which both find satisfaction and

More information

Patterns and predictors of dual contraceptive use among sexually active treatment experienced women living with HIV in British Columbia, Canada.

Patterns and predictors of dual contraceptive use among sexually active treatment experienced women living with HIV in British Columbia, Canada. Patterns and predictors of dual contraceptive use among sexually active treatment experienced women living with HIV in British Columbia, Canada. Sophie Patterson 1,2, Wendy Zhang 1, Kate Salters 1, Yalin

More information

How can you improve. Talk to your patients about side effects and how long treatment will take. For personal use only

How can you improve. Talk to your patients about side effects and how long treatment will take. For personal use only For mass reproduction, content licensing and permissions contact Dowden Health Media. Family Practice the journal of Charlotte Brown, PhD, Deena R. Battista, PhD Department of Psychiatry, of Medicine,

More information

The leading cause of death in the United States is coronary

The leading cause of death in the United States is coronary Overcoming Inertia: Improvement in Achieving Target Low-density Lipoprotein Cholesterol Kenneth C. Goldberg, MD; Stephanie D. Melnyk, PharmD; and David L. Simel, MD, MHS Objective: To improve lipid management

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Viktorin A, Uher R, Kolevzon A, Reichenberg A, Levine SZ, Sandin S. Association of antidepressant medication use during pregnancy with intellectual disability in offspring.

More information