Pharmacologic Response to a Diagnosis of Late-Life Depression: A Population Study in Quebec

Sewitch, Maida; Blais, Régis; Rahme, Elham; Galarneau, Sophie; Bexton, Brian

doi:10.1177/070674370605100605

Cited by 11 publications

(6 citation statements)

References 39 publications

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“…The presence of a physician diagnosis of a CMD was based on information reported in provincial health administrative databases in the 6 months prior and following the baseline and followup interviews. The following International Classification of Disease (ICD-9, ICD-10) diagnostic codes were considered for depression: 311.0; 311.9; 300.4; F32; F33; F34.1 [31][32][33][34][35]. The codes 300.0, 300.2, F40 and F41 were included for anxiety disorders [34,35].…”

Section: Common Mental Disorders (Cmd)mentioning

confidence: 99%

Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults

Lamoureux‐Lamarche

Berbiche

Vasiliadis

2021

Health Qual Life Outcomes

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Background Studies on the long-term outcomes of receiving adequate treatment for depression and anxiety disorders are scarce. The aims of this study were to assess the association between adequacy of care and remission of common mental disorders (CMD) and change in quality of life among a population of older adults consulting in primary care. Methods The study was conducted among 225 older adults with a CMD who participated in the longitudinal ESA-Services study. Adequacy of care was assessed using administrative and self-reported data and was based on Canadian guidelines and relevant literature. CMD were measured at baseline and follow-up using self-reported measures (DSM-5 criteria) and physician diagnostic codes (International Classification of Diseases, 9th and 10th revisions) for depression and anxiety disorders. The remission of CMD was defined by the presence of at least one disorder at baseline and absence at follow-up. Quality of life was measured at baseline and follow-up using a visual analog scale and the Satisfaction With Life Scale. To estimate the probability to receive adequate/inadequate care, a propensity score was calculated, and analyses were weighted by the inverse probability. Weighted multivariable analyses were carried out to assess the remission of CMD and change in quality of life as a function of adequacy of care controlling for individual and health system factors. Results Results showed that 40% of older adults received adequate care for CMD and 55% were in remission at follow-up. Adequacy of care was associated with remission of CMD (AOR: 0.66; CI 0.45–0.97; p-value: 0.032). Participants receiving adequate care had an improvement between baseline and follow-up of 0.7 (beta: 0.69, CI 0.18; 1.20, p = 0.008) point on the Satisfaction With Life Scale, while a marginal association was observed with improvement in HRQOL (beta: 2.83, CI 0.12; 5.79, p = 0.060). Conclusion The findings contribute to the rare observational studies on the association between adequacy of care for CMD and long-term treatment effects. Future studies on population effectiveness should focus on patient indicators of quality of care which may better predict long-term outcomes for patients with depression and anxiety.

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Section: Common Mental Disorders (Cmd)mentioning

confidence: 99%

Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults

Lamoureux‐Lamarche

Berbiche

Vasiliadis

2021

Health Qual Life Outcomes

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“…23 The presence of a physician diagnosis of CMD, in the 6 months surrounding the baseline and follow-up, was assessed with the International Classification of Diseases 9th and 10th revisions codes. 24 - 27 Based on the presence/absence of CMD at baseline and follow-up, the course of CMD was categorized as follows: no CMD, remitted case, incident case and persistent case.…”

Section: Methodsmentioning

confidence: 99%

Perceived Need for Mental Health Care and Associated Factors and Outcomes in Older Adults Consulting in Primary Care

2021

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Objective To assess the individual and health system factors and health-related outcomes associated with perceived need for mental health care in older adults consulting in primary care. Method This longitudinal cohort study was conducted among 771 cognitively intact older adults aged ≥65 years recruited in primary care practices in Quebec between 2011 and 2013 and followed 4 years later. Predisposing, enabling and need factors were based on Andersen’s framework on help-seeking behaviors. Health-related outcomes included course of common mental disorders (CMDs), change in quality of life and societal costs. Perceived need for care (PNC) was categorized as no need, met and unmet need. Multinomial regression analyses were conducted to assess the association between study variables and PNC in the overall and the subsample of participants with a CMD at baseline. Results As compared with individuals reporting no need, those with an unmet need were more likely to have cognitive decline and lower continuity of care; while those with a met need were more likely to report decreased health-related quality of life. As compared with individuals with an unmet need, those reporting a met need were more likely to report ≥ 3 physical diseases and an incident and persistent CMD, and less likely to show cognitive decline. In participants with a CMD, individuals reporting a met as compared with no need were more likely to be categorized as receiving minimally adequate care and a persistent CMD. Need for care was not associated with societal costs related to health service use. Conclusions Overall, physicians should focus on individuals with cognitive impairment and lower continuity of care which was associated with unmet mental health need. Improved follow-up in these populations may improve health care needs and outcomes.

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“…Previous studies, in older adults and mixed-age populations, on the adequacy of the antidepressant therapy have underlined a number of associated factors. Many have shown individual predisposing factors such as age, sex, race, education level [ 8 – 11 ] as well as need factors such as perceived need for medication, co-morbidity of depression and anxiety, and physical health status to be associated with adequate antidepressant therapy [ 10 , 12 , 13 ]. Healthcare system facilitating factors such as mental health specialty, physician use of depression treatment algorithms, health insurance coverage and number of follow-up visits to the prescribing physician have also been associated with receipt of adequate antidepressant therapy [ 9 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants of follow-up care associated with incident antidepressant use in older adults

2017

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ObjectivesTo determine the proportion of older adults receiving guideline concordant antidepressant therapy and to determine patient, prescriber and organizational factors associated with adequate antidepressant therapy.MethodsThe study included secondary analyses of data collected in the Étude sur la Santé des Aînés (ESA) Services study on older adults recruited while consulting in primary care clinics in one of the largest health regions of the province of Québec. Antidepressant users (n = 349) were identified from information collected from the Régie de l’Assurance Maladie du Québec (RAMQ) pharmaceutical database which holds information on all drugs dispensed to all residents covered under the public drug plan. Adequacy of antidepressant treatment was measured using three criteria: adequacy of daily dose; length of prescription (≥455 days); and ≥3 visits to the antidepressant-prescribing physician in the first 3 months after initiation of therapy. Multivariate logistic regression analyses were used to study antidepressant treatment adequacy as a function of individual, provider and healthcare system factors.ResultsAmong the antidepressant users, 44% received an adequate antidepressant treatment filling all three criteria. None of the factors studied were associated with the probability of receiving adequate treatment filling all three criteria. Psychological distress was associated with having an adequate number of visits in the 3 months following initiation. Males and those living in a metropolitan and urban area were less likely to receive an adequate dose.ConclusionsFuture research should consider factors associated with perceived effectiveness and patient treatment preferences that may explain receipt of adequate antidepressant treatment in older adults.

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Pharmacologic Response to a Diagnosis of Late-Life Depression: A Population Study in Quebec

Abstract: Male sex and continuity of care predicted that patients had the recommended medication dispensed.

Cited by 11 publications

References 39 publications

Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults

Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults

Perceived Need for Mental Health Care and Associated Factors and Outcomes in Older Adults Consulting in Primary Care

Determinants of follow-up care associated with incident antidepressant use in older adults

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