Objective
Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients.
Design
Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients.
Participants
One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician.
Measurement
Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure.
Results
At four-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African-American subjects (n=82) had significantly lower rates of four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African-American women and white women in reported four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =2.42, df=1, p<0.02).
Conclusions
The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.
Background
Ambulatory care visits for chronic sinusitis outnumber visits for acute sinusitis. The majority of these visits are with non-otolaryngologists. In order to better understand patients diagnosed with chronic sinusitis by non-otolaryngologists, we sought to determine if incident cases of chronic sinusitis diagnosed by primary care (PC) or emergency medicine (EM) providers meet diagnostic criteria.
Methods
Retrospective cohort. Patients were identified using administrative data, 2005–2006. The dataset was then clinically annotated based on chart review. We excluded prevalent cases.
Results
We identified 114 patients with newly diagnosed chronic sinusitis in EM (75) or PC settings (39). Rhinorrhea (EM 61%, PC 59%) and nasal obstruction (EM 67%, PC 64%) were common in both settings but facial fullness (EM 80%, PC 39%) and pain (EM 40%, PC 18%) were more common in the EM setting. Few patients reported symptoms of 90 days or longer (EM 6.0%, PC 24%) and no patient had evidence of inflammation on physical examination. A minority of patients received a sinus CT scan (22.8%) or nasal endoscopy (1.8%). In total only 1 patient diagnosed with chronic sinusitis met the diagnostic criteria.
Conclusions
Most patients diagnosed with chronic sinusitis by non-otolaryngologists do not have the condition. Caution should be used in studying chronic sinusitis using administrative data from non-otolaryngology providers as a large proportion of the patients may not actually have the disease.
Objectives and Hypothesis
Our objectives were to characterize the quality of acute sinusitis care and to identify non-clinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider level factors associated with antibiotic use.
Study Design
Retrospective cohort at a single academic institution.
Methods
We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005 and December 31, 2006. We used identify factors associated with receipt of antibiotics.
Results
We find that 66.0% of patients with mild symptoms of short duration are given antibiotics and that non-clinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics and emergency medicine providers use more antibiotics for acute sinusitis.
Conclusions
Antibiotics continue to be over used for patients with mild acute sinusitis of short duration. Non-clinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee significantly influence use of antibiotics for acute sinusitis.
The focus group setting provided insight to the language used by older, church-going African-Americans to describe depression. Implications include the advantages of using qualitative data to help inform clinical encounters with older African-Americans.
The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for older adults should take into account the potential impact of race and gender on adherence to prescribed medications.
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