Health Outcomes Associated with Adherence to Antidepressant Use during Acute and Continuation Phases of Depression Treatment among Older Adults with Dementia and Major Depressive Disorder

Autor:	Daniel C. Malone, Sandipan Bhattacharjee, Wei-Hsuan Lo-Ciganic, William J. Burke, Asad E. Patanwala, Shannon M. Knapp, Suniya Naeem, Nina Vadiei, Jeannie K. Lee
Rok vydání:	2020
Předmět:	medicine.medical_specialty lcsh:Medicine all-cause hospitalization Health outcomes Article 03 medical and health sciences 0302 clinical medicine Internal medicine falls/fractures Medicine Dementia adherence 030212 general & internal medicine Medical prescription business.industry Proportional hazards model lcsh:R Retrospective cohort study General Medicine Healthcare Effectiveness Data and Information Set medicine.disease antidepressants depression all-cause mortality Major depressive disorder Antidepressant business 030217 neurology & neurosurgery dementia
Zdroj:	Journal of Clinical Medicine Volume 9 Issue 10 Journal of Clinical Medicine, Vol 9, Iss 3358, p 3358 (2020)
ISSN:	2077-0383
DOI:	10.3390/jcm9103358
Popis:	Objectives: To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults with dementia and major depressive disorder (MDD). Design: Retrospective cohort study. Setting: Medicare 5% sample data (2011&ndash 2013). Participants: Older adults (aged 65 years or older) with dementia and MDD. Measurements: The first antidepressant prescription claim from 1 May 2011 through 30 April 2012 was considered the index prescription start date (IPSD). Adherence during acute- and continuation-phase AMM was based on HEDIS guidelines. Study outcomes included all-cause mortality, all-cause hospitalization, and falls/factures (with mortality being the competing event for hospitalization and falls/fractures) during follow-up from end of acute-/continuation-phase AMM adherence. Due to the proportionality assumption violation of Cox models, fully non-parametric approaches (Kaplan&ndash Meier and modified Gray&rsquo s test) were used for time-to-event analysis adjusting for the inverse probability of treatment weights. Results: Final study samples consisted of 4330 (adherent (N) = 3114 (71.92%)) and 3941 (adherent (N) = 2407 (61.08%)) older adults with dementia and MDD during acute- and continuation-phase treatments, respectively. No significant difference (p > 0.05) between adherent and non-adherent groups was observed for all-cause mortality and falls/fractures in both the acute and continuation phases. There was a significant difference in time to all-cause hospitalization during acute-phase treatment (p = 0.018), with median times of 530 (95% CI: 499&ndash 587) and 425 (95% CI: 364&ndash 492) days for adherent and non-adherent groups, respectively. Conclusions: Acute-phase adherence to HEDIS AMM was associated with reductions in all-cause hospitalization risk among older adults with dementia and MDD.
Databáze:	OpenAIRE
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