Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

2006 HSR&D National Meeting Abstract


3087 — Identifying Gaps in Guideline Concordant Care for MDD: A National Study

Author List:
Schutte KK (CHCE)
Dalton AL (CHCE)

Objectives:
The rate of guideline concordant care (GCC) for Major Depressive Disorder (MDD) should be improved. We aimed to (1) identify gaps in the provision of GCC among a national sample of outpatients diagnosed with MDD and (2) identify patient or clinical characteristics associated with the non-provision of GCC that could be targeted in interventions aimed at increasing the rate of GCC.

Methods:
Pharmacy Benefits Management data were obtained for all VA outpatients diagnosed with MDD (ICD9 codes from the series 296.2 and 296.3) and no bipolar or schizophrenia diagnoses in FY99 according to the VA’s National Patient Care Database (NPCD). A total of 66,200 patients were diagnosed with MDD during FY99. GCC for the acute phase of treatment was operationalized using the VA/Department of Defense’s MDD Clinical Practice Guidelines (CPG), which specify the minimum amounts (individualized for each antidepressant) and length of time medications need to be prescribed in order to meet criteria for GCC. Separate guidelines are available for treating adults under and over age 65. To be considered GCC, guideline-specified amounts of antidepressant medication had to be prescribed for a minimum of 12 weeks. Demographic and clinical characteristics were obtained from the NPCD. Analyses comprised chi-squares; given the large sample size, caution was taken when evaluating significance tests.

Results:
Approximately 52% of all MDD patients received GCC. There were no gender or racial differences in the rate of GCC, and GCC rates were similar for patients regardless of whether they had a co-occurring substance use disorder. However, older patients (> 65) were less likely to have received GCC than were younger adults (48% v. 53%, respectively; chi-square = 116.38, df = 1, p < .001). Among the 31,624 MDD patients who did not receive GCC, 79% had been prescribed an antidepressant medication; however, less than 2% received a guideline-specified amount of medication.

Implications:
About half of patients with identified MDD did not receive GCC. Interventions to improve the rate of GCC should target the provision of adequate dosages of antidepressant medication, especially among older adults.

Impacts:
Study findings highlight the need for effective interventions to improve provision of GCC for MDD.