Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3047 — Predictors of Evidence-Based Depression Treatment in Veterans with COPD and Co-Morbid Depression

Jordan N (Midwest Center for Health Services Policy & Research, Hines VA Hospital) , Lee TA (Midwest Center for Health Services Policy & Research, Hines VA Hospital), Valenstein M (Serious Mental Illness Treatment Research and Evaluation Center, VA Center for Practice Management & Outcomes Research, Ann Arbor VA Hospital), Weiss KB (Midwest Center for Health Services Policy & Research, Hines VA Hospital)

Objectives:
Chronic obstructive pulmonary disorder (COPD) patients frequently have co-occurring depressive disorders. Adequate disease management may diminish as patients experience multiple disorders. The objectives of this study are to examine the prevalence of guideline-consistent depression treatment in patients with COPD and depression, and determine whether receipt of guideline-consistent treatment differed by treatment setting.

Methods:
A sample of veterans with COPD that experienced a new episode of major depressive disorder (MDD) was identified. New depression episodes were defined as one of the following: primary diagnosis of MDD in any setting, secondary diagnosis of MDD during a hospitalization, or >=2 secondary diagnoses of MDD on different days within a 12-month period in any outpatient setting. Patients with schizophrenia or bipolar disorder, extended care stays, those not receiving medications from the VA, those with depression diagnoses within 120 days of the new episode, and those being actively treated with antidepressants were excluded. Guideline consistent care was defined as 84 days of antidepressants and at least 3 follow-up visits during the 12 weeks following initial diagnosis. The care settings in which patients were seen during the acute phase of their depression were categorized using 6 mutually exclusive groups, including: primary care only, mental health only, primary care & mental health, primary care & pulmonary care, primary care & mental health & pulmonary care, or other. Logistic regression was used to analyze concordance with VA treatment guidelines for depression and the relationship between guideline-consistent depression treatment and clinic care settings.

Results:
Of the 5,517 veterans included, the proportion of patients receiving guideline consistent care was 50.6% for antidepressants, 16.3% for follow-up visits, and 9.9% for both. Being seen in a mental health clinic during the acute phase was associated with a 7-fold increase in the odds of receiving guideline-consistent care compared to primary care only. Younger patients, whites, and patients with psychiatric co-morbidities were more likely to receive guideline concordant care.

Implications:
Most VA patients with COPD and an acute depressive episode receive suboptimal depression management. Improvements in depression treatment may be particularly important for patients seen exclusively in primary care.

Impacts:
These findings suggest the need to either increase mental health services use for these patients or develop enhanced primary care and pulmonary care capacity to treat depression for COPD patients.