Young AS, Sherbourne CD, Wells KB, Klap R, Burnam MA; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 443-4.
Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles 90095, USA.
RESEARCH OBJECTIVE: There are significant concerns regarding the quality of care being provided for psychiatric disorders, and the potential effect on treatment quality of ongoing changes in the organization and financing of care. Depressive and anxiety disorders are common conditions and responsible for substantial disability and reductions in quality of life. A variety of studies have examined the quality of care provided for these disorders in treatment organizations or insured populations, and found significant quality problems. However, much less is known regarding important quality problems in community-based populations, or what differences exist between communities in treatment quality. There is also a need for updated information about the effect that new medications and current treatment resources are having on quality of care. STUDY DESIGN: Data are from the 1998 Health Care for Communities project, and are based on a telephone survey of about 10,000 adults residing in 60 U.S. communities. Respondents were sampled from participants in the 1996-97 Community Tracking Study. Communities and individuals were selected and weighted to be nationally representative. Clinical information was obtained using brief diagnostic screeners for major depression, dysthymia, panic disorder, generalized anxiety disorder (GAD), and hazardous alcohol consumption during th epast year. Appropriateness of care was evaluated using the diagnostic screeners and responses regarding utilization of counseling and medication treatment. Adequate antidepressant medication was defined as regular use, for at least a month, of an antidepressant medication at an adequate dosage. For depressive disorders, appropriate medication treatment consisted of use of adequate antidepressant medication. For anxiety disorders, appropriate medication treatment consisted of use of adequate antidepressant medication or a benzodiazepine medication. PRINCIPAL FINDINGS: Selective Serotonin Reuptake Inhibitors are the most commonly prescribed class of antidepressant medication (61% of antidepressant prescriptions), and the class most likely to be used at an adequate dosage (adequate dosage in 82% of prescriptions, vs. 49% for other newer medications and 28% for heterocyclic medications). In depressive disorders, between 27% and 47% of individuals receive counseling and between 13% and 25% receive appropriate medication treatment. Rates of utilization of counseling and antidepressant medication are higher for double depression than for dysthymia or major depression alone. In anxiety disorders, counseling is received by 20% with GAD and 32% with panic, and appropriate medication treatment received by 22% with GAD and 21% with panic. Findings regarding variation in treatment quality by community, insurance status, and individual characteristic will be presented for each of the disorders. CONCLUSIONS: Fifty-eight perrcent of individuals with anxiety disorders and 68% of individuals with depressive disorders receive no appropriate treatment. Also, despite the widespread use of antidepressant medications that are likely to be prescribed at an effective dosage, less than a quarter of individuals with major depression are receiving appropriate medication treatment. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Interventions are needed to improve the quality of care for anxiety and depressive disorders throughout the United States. With the advent of newer medications that are easier to use, these interventions should focus on improving access to effective medication management and psychotherapy.
Publication Types:
Keywords:
- Adult
- Antidepressive Agents
- Anxiety Disorders
- Benzodiazepines
- Cognitive Therapy
- Counseling
- Depression
- Depressive Disorder
- Depressive Disorder, Major
- Dysthymic Disorder
- Humans
- Mental Disorders
- Panic Disorder
- Psychotherapy
- Serotonin Uptake Inhibitors
- United States
- hsrmtgs
Other ID:
UI: 102193879
From Meeting Abstracts