Use of Antidepressant Medications: Are There Differences in Psychiatric Visits among Patient Treatments in the Veterans Administration?
Background: Information on the effectiveness of newer antidepressants like serotonin-norepinephrine reuptake inhibitors in terms of healthcare utilization is limited. Treatment guidelines affect evaluation. Second-line medications are usually prescribed to patients with higher utilization. Objective...
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| Veröffentlicht in: | Medical care 2004-06, Vol.42 (6), p.551-559 |
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| creator | Alaa Hamed Lee, Austin Ren, Xinhua S. Miller, Donald R. Fran Cunningham Zhang, Huan Kazis, Lewis E. |
| description | Background: Information on the effectiveness of newer antidepressants like serotonin-norepinephrine reuptake inhibitors in terms of healthcare utilization is limited. Treatment guidelines affect evaluation. Second-line medications are usually prescribed to patients with higher utilization. Objectives: The objective of this study was to compare antidepressants within the Veterans Affairs (VA) healthcare system on the basis of the number of outpatient psychiatric visits for each class of antidepressants. Research Design and Subjects: We conducted a retrospective cohort design using precollected information from VA national databases from 1999 and 2000. The study identified 92,537 patients on serotonin specific reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs). Measures: We stratified individual patients by the number of visits in the baseline year for each medication class. For each stratum, we created a dichotomized variable$Y_{K}:Y_{K}=1$if there is a reduction of K visits or more and 0 if there is no reduction. We calculated the odds of reduction of psychiatric visits among the 3 classes of antidepressants. Results: TCAs and SSRIs were associated with greater odds of reduction compared with SNRIs at the level of 1 through 10 or 11 visits, respectively. SNRIs were associated with greater odds of reduction in visits at the level of 14, 16, or more visits compared with SSRIs and TCAs, respectively (P |
| doi_str_mv | 10.1097/01.mlr.0000128002.73998.87 |
| format | Article |
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Treatment guidelines affect evaluation. Second-line medications are usually prescribed to patients with higher utilization. Objectives: The objective of this study was to compare antidepressants within the Veterans Affairs (VA) healthcare system on the basis of the number of outpatient psychiatric visits for each class of antidepressants. Research Design and Subjects: We conducted a retrospective cohort design using precollected information from VA national databases from 1999 and 2000. The study identified 92,537 patients on serotonin specific reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs). Measures: We stratified individual patients by the number of visits in the baseline year for each medication class. For each stratum, we created a dichotomized variable$Y_{K}:Y_{K}=1$if there is a reduction of K visits or more and 0 if there is no reduction. We calculated the odds of reduction of psychiatric visits among the 3 classes of antidepressants. Results: TCAs and SSRIs were associated with greater odds of reduction compared with SNRIs at the level of 1 through 10 or 11 visits, respectively. SNRIs were associated with greater odds of reduction in visits at the level of 14, 16, or more visits compared with SSRIs and TCAs, respectively (P <0.05). SSRIs were associated with greater odds of reduction compared with TCAs at the level of 1 to 11 visits (P <0.05); there were no significant differences between the 2 classes above 11 visits. Conclusion: Effectiveness research using databases should consider how medications are prescribed within systems. Treatment guidelines result in differences in severity and utilization among users of different medications.</description><identifier>ISSN: 0025-7079</identifier><identifier>EISSN: 1537-1948</identifier><identifier>DOI: 10.1097/01.mlr.0000128002.73998.87</identifier><identifier>PMID: 15167323</identifier><identifier>CODEN: MELAAD</identifier><language>eng</language><publisher>United States: J. B. Lippincott Williams and Wilkins Inc</publisher><subject>Adolescent ; Adult ; Aged ; Antidepressants ; Antidepressive Agents - classification ; Antidepressive Agents - therapeutic use ; Antidepressive Agents, Second-Generation - therapeutic use ; Antidepressive Agents, Tricyclic - therapeutic use ; Clinical outcomes ; Cohort Studies ; Comorbidity ; Databases, Factual ; Depressive Disorder, Major - complications ; Depressive Disorder, Major - diagnosis ; Depressive Disorder, Major - drug therapy ; Depressive disorders ; Disabilities ; Drug Utilization ; Dysthymic disorder ; Female ; Health care industry ; Hospitalization - statistics & numerical data ; Hospitals, Veterans - statistics & numerical data ; Humans ; Length of stay ; Major depressive disorder ; Male ; Medications ; Mental health care ; Middle Aged ; Outpatient Clinics, Hospital - statistics & numerical data ; Reuptake ; Serotonin agents ; Serotonin Uptake Inhibitors - therapeutic use ; United States ; United States Department of Veterans Affairs ; Veterans</subject><ispartof>Medical care, 2004-06, Vol.42 (6), p.551-559</ispartof><rights>Copyright 2004 Lippincott Williams & Wilkins</rights><rights>2004 Lippincott Williams & Wilkins, Inc.</rights><rights>Copyright Lippincott Williams & Wilkins Jun 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3517-ea884ce58ee3dcbf113baf81fea9bc8a9ef0eccee3a93dd9ca164328e0fec123</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4640787$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4640787$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>315,782,786,805,27933,27934,58026,58259</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15167323$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alaa Hamed</creatorcontrib><creatorcontrib>Lee, Austin</creatorcontrib><creatorcontrib>Ren, Xinhua S.</creatorcontrib><creatorcontrib>Miller, Donald R.</creatorcontrib><creatorcontrib>Fran Cunningham</creatorcontrib><creatorcontrib>Zhang, Huan</creatorcontrib><creatorcontrib>Kazis, Lewis E.</creatorcontrib><title>Use of Antidepressant Medications: Are There Differences in Psychiatric Visits among Patient Treatments in the Veterans Administration?</title><title>Medical care</title><addtitle>Med Care</addtitle><description>Background: Information on the effectiveness of newer antidepressants like serotonin-norepinephrine reuptake inhibitors in terms of healthcare utilization is limited. Treatment guidelines affect evaluation. Second-line medications are usually prescribed to patients with higher utilization. Objectives: The objective of this study was to compare antidepressants within the Veterans Affairs (VA) healthcare system on the basis of the number of outpatient psychiatric visits for each class of antidepressants. Research Design and Subjects: We conducted a retrospective cohort design using precollected information from VA national databases from 1999 and 2000. The study identified 92,537 patients on serotonin specific reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs). Measures: We stratified individual patients by the number of visits in the baseline year for each medication class. For each stratum, we created a dichotomized variable$Y_{K}:Y_{K}=1$if there is a reduction of K visits or more and 0 if there is no reduction. We calculated the odds of reduction of psychiatric visits among the 3 classes of antidepressants. Results: TCAs and SSRIs were associated with greater odds of reduction compared with SNRIs at the level of 1 through 10 or 11 visits, respectively. SNRIs were associated with greater odds of reduction in visits at the level of 14, 16, or more visits compared with SSRIs and TCAs, respectively (P <0.05). SSRIs were associated with greater odds of reduction compared with TCAs at the level of 1 to 11 visits (P <0.05); there were no significant differences between the 2 classes above 11 visits. Conclusion: Effectiveness research using databases should consider how medications are prescribed within systems. Treatment guidelines result in differences in severity and utilization among users of different medications.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antidepressants</subject><subject>Antidepressive Agents - classification</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Antidepressive Agents, Second-Generation - therapeutic use</subject><subject>Antidepressive Agents, Tricyclic - therapeutic use</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Databases, Factual</subject><subject>Depressive Disorder, Major - complications</subject><subject>Depressive Disorder, Major - diagnosis</subject><subject>Depressive Disorder, Major - drug therapy</subject><subject>Depressive disorders</subject><subject>Disabilities</subject><subject>Drug Utilization</subject><subject>Dysthymic disorder</subject><subject>Female</subject><subject>Health care industry</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals, Veterans - statistics & numerical data</subject><subject>Humans</subject><subject>Length of stay</subject><subject>Major depressive disorder</subject><subject>Male</subject><subject>Medications</subject><subject>Mental health care</subject><subject>Middle Aged</subject><subject>Outpatient Clinics, Hospital - statistics & numerical data</subject><subject>Reuptake</subject><subject>Serotonin agents</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><issn>0025-7079</issn><issn>1537-1948</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd9uFCEUxonR2LX6BsaQXng3IwzDAL0xm6qtSY29WHtLWObgss4wKzBp-gS-tuyf2EQuOMD5ne-Q8yF0QUlNiRIfCK3HIdakLNpIQppaMKVkLcUztKCciYqqVj5Hi5LilSBCnaFXKW0LLhhvXqIzymknWMMW6M-PBHhyeBmy72EXISUTMv4Gvbcm-ymkS7yMgFcbKPsn71yJwULCPuC79Gg33uToLb73yeeEzTiFn_iulEKRWUUweSynA543gO8hQzQh4WU_-uBTjocuH1-jF84MCd6c4jlaffm8urqpbr9ff71a3laWcSoqMFK2FrgEYL1dO0rZ2jhJHRi1ttIocASsLVmjWN8ra2jXskYCcWBpw87R-6PsLk6_Z0hZjz5ZGAYTYJqTFlR1kjddAS_-A7fTHEP5mm6IaHkZHy_Q5RGycUopgtO76EcTHzUlem-VJlQXq_STVfpglZaiFL87dZjXI_RPpSdvCtAegYdpKENLv4b5AaLegBny5iDJO06qhpCWdOVW7Z_2um-PZduUp_hPtu1aIkrbv6a_rPg</recordid><startdate>20040601</startdate><enddate>20040601</enddate><creator>Alaa Hamed</creator><creator>Lee, Austin</creator><creator>Ren, Xinhua S.</creator><creator>Miller, Donald R.</creator><creator>Fran Cunningham</creator><creator>Zhang, Huan</creator><creator>Kazis, Lewis E.</creator><general>J. B. Lippincott Williams and Wilkins Inc</general><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20040601</creationdate><title>Use of Antidepressant Medications: Are There Differences in Psychiatric Visits among Patient Treatments in the Veterans Administration?</title><author>Alaa Hamed ; Lee, Austin ; Ren, Xinhua S. ; Miller, Donald R. ; Fran Cunningham ; Zhang, Huan ; Kazis, Lewis E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3517-ea884ce58ee3dcbf113baf81fea9bc8a9ef0eccee3a93dd9ca164328e0fec123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antidepressants</topic><topic>Antidepressive Agents - classification</topic><topic>Antidepressive Agents - therapeutic use</topic><topic>Antidepressive Agents, Second-Generation - therapeutic use</topic><topic>Antidepressive Agents, Tricyclic - therapeutic use</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Databases, Factual</topic><topic>Depressive Disorder, Major - complications</topic><topic>Depressive Disorder, Major - diagnosis</topic><topic>Depressive Disorder, Major - drug therapy</topic><topic>Depressive disorders</topic><topic>Disabilities</topic><topic>Drug Utilization</topic><topic>Dysthymic disorder</topic><topic>Female</topic><topic>Health care industry</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals, Veterans - statistics & numerical data</topic><topic>Humans</topic><topic>Length of stay</topic><topic>Major depressive disorder</topic><topic>Male</topic><topic>Medications</topic><topic>Mental health care</topic><topic>Middle Aged</topic><topic>Outpatient Clinics, Hospital - statistics & numerical data</topic><topic>Reuptake</topic><topic>Serotonin agents</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alaa Hamed</creatorcontrib><creatorcontrib>Lee, Austin</creatorcontrib><creatorcontrib>Ren, Xinhua S.</creatorcontrib><creatorcontrib>Miller, Donald R.</creatorcontrib><creatorcontrib>Fran Cunningham</creatorcontrib><creatorcontrib>Zhang, Huan</creatorcontrib><creatorcontrib>Kazis, Lewis E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alaa Hamed</au><au>Lee, Austin</au><au>Ren, Xinhua S.</au><au>Miller, Donald R.</au><au>Fran Cunningham</au><au>Zhang, Huan</au><au>Kazis, Lewis E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of Antidepressant Medications: Are There Differences in Psychiatric Visits among Patient Treatments in the Veterans Administration?</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>2004-06-01</date><risdate>2004</risdate><volume>42</volume><issue>6</issue><spage>551</spage><epage>559</epage><pages>551-559</pages><issn>0025-7079</issn><eissn>1537-1948</eissn><coden>MELAAD</coden><abstract>Background: Information on the effectiveness of newer antidepressants like serotonin-norepinephrine reuptake inhibitors in terms of healthcare utilization is limited. Treatment guidelines affect evaluation. Second-line medications are usually prescribed to patients with higher utilization. Objectives: The objective of this study was to compare antidepressants within the Veterans Affairs (VA) healthcare system on the basis of the number of outpatient psychiatric visits for each class of antidepressants. Research Design and Subjects: We conducted a retrospective cohort design using precollected information from VA national databases from 1999 and 2000. The study identified 92,537 patients on serotonin specific reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs). Measures: We stratified individual patients by the number of visits in the baseline year for each medication class. For each stratum, we created a dichotomized variable$Y_{K}:Y_{K}=1$if there is a reduction of K visits or more and 0 if there is no reduction. We calculated the odds of reduction of psychiatric visits among the 3 classes of antidepressants. Results: TCAs and SSRIs were associated with greater odds of reduction compared with SNRIs at the level of 1 through 10 or 11 visits, respectively. SNRIs were associated with greater odds of reduction in visits at the level of 14, 16, or more visits compared with SSRIs and TCAs, respectively (P <0.05). SSRIs were associated with greater odds of reduction compared with TCAs at the level of 1 to 11 visits (P <0.05); there were no significant differences between the 2 classes above 11 visits. Conclusion: Effectiveness research using databases should consider how medications are prescribed within systems. Treatment guidelines result in differences in severity and utilization among users of different medications.</abstract><cop>United States</cop><pub>J. B. Lippincott Williams and Wilkins Inc</pub><pmid>15167323</pmid><doi>10.1097/01.mlr.0000128002.73998.87</doi><tpages>9</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Antidepressants Antidepressive Agents - classification Antidepressive Agents - therapeutic use Antidepressive Agents, Second-Generation - therapeutic use Antidepressive Agents, Tricyclic - therapeutic use Clinical outcomes Cohort Studies Comorbidity Databases, Factual Depressive Disorder, Major - complications Depressive Disorder, Major - diagnosis Depressive Disorder, Major - drug therapy Depressive disorders Disabilities Drug Utilization Dysthymic disorder Female Health care industry Hospitalization - statistics & numerical data Hospitals, Veterans - statistics & numerical data Humans Length of stay Major depressive disorder Male Medications Mental health care Middle Aged Outpatient Clinics, Hospital - statistics & numerical data Reuptake Serotonin agents Serotonin Uptake Inhibitors - therapeutic use United States United States Department of Veterans Affairs Veterans |
| title | Use of Antidepressant Medications: Are There Differences in Psychiatric Visits among Patient Treatments in the Veterans Administration? |
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