Powers RL, Kniesner TJ, Croghan TW; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Regina L.H. Powers, Ph.D., J.D, US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Parklawn Building, Room 16-105, 5600 Fishers Lane, Rockville, MD 20857. Tel: 301-443-1596; Fax: 301-443-9847; E-mail: rpowers@samsha.gov
Research Objective: Use of antidepressants in primary care has dramatically increased since the introduction of the selective serotonin reuptake inhibitors (SSRIs) in 1988. Although medication-only treatment in primary care is adequate for some depressed individuals, many will also require psychotherapy. This paper examines the correlates of psychotherapy among antidepressant recipients in the SSRI era.Study Design: The data for this study represent a subset of MarketScan(, a comprehensive database of medical and pharmacy insurance claims for approximately 700,000 individuals with employer provider health insurance, maintained by The Medstat Group, Ann Arbor, MI. Antidepressant recipients with a diagnosis of depression during the years 1992-1996 were included in the study (N=7,394). We constructed 18-month episodes of care. The six months prior to the initial diagnosis of depression and initiation of antidepressant treatment constituted the pre-period during which there was no apparent diagnosis of or treatment for depression. Provider type was assigned by the specialty of the provider on the first claim indicating depression as a diagnosis. The principal outcome measure, assessed by multivariate regression techniques, was the number of psychotherapy visits in the 12 months following initiation of antidepressant treatment. We used two-stage sample selection models to adjust for unobserved differences in provider choice. Explanatory variables included demographic characteristics, pre-period costs and use of psychotherapy for non-depression reasons, and certain characteristics of the health plan, including use of case or utilization management, the availability of an employee assistance program, and the level of coinsurance.Population Studied: Depressed individuals with employer provided health insurance.Principal Findings: In spite of extensive testing of alternative specifications, the provider choice models were not predictive of psychotherapy. Significant predictors of psychotherapy use during the post-treatment period included use of a psychiatrist (OR = 2.43) or a non-physician mental health specialist (OR = 1.39) rather than a primary care provider; use of case or utilization management (OR = 0.874); major depression (OR = 1.37); use of anxiolytics (OR = 1.02); prior period psychotherapy (OR = 1.33); and high medical utilization in the pre-period (OR = 1.32). The level of coinsurance for mental health visits was not associated with use of psychotherapy. Correction for unobserved variables with regard to provider choice was not significant.Conclusions: Initial choice of a mental health specialist was significantly associated with psychotherapy use among antidepressant recipients. Provider choice was not predictable based on the characteristics available in these claims data. Implications for Policy, Delivery, or Practice. The choice of a primary care provider may restrict access to psychotherapy. Further study is needed to determine the long-term outcome of depressed individuals treated in primary care compared to those treated in more integrated models.Primary Funding Source: Eli Lilly and Company
Publication Types:
Keywords:
- Antidepressive Agents
- Choice Behavior
- Cognitive Therapy
- Depression
- Depressive Disorder
- Depressive Disorder, Major
- Health Services Needs and Demand
- Mental Disorders
- Primary Health Care
- Psychiatry
- Psychotherapy
- Serotonin Uptake Inhibitors
- diagnosis
- utilization
- hsrmtgs
Other ID:
UI: 102272143
From Meeting Abstracts