3039 — Outcomes of Minimal Depression Treatment and Follow-up Measures for Women Veterans

Lam CA, HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System; Sherbourne CD, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System; Rubenstein LV, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System; Huynh AK, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System; Lee ML, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System; Chu K, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System; Fickel JJ, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System; Gelberg L, Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System; Farmer-Coste MM, HSR&D CSHIIP, VA Greater Los Angeles Healthcare System;

Objectives:
Operationalizing VHA's commitment to equitable care for Women Veterans is a national priority. Major depression is twice as common among women as men. Little is known about gender differences in providing a minimal course of treatment and follow-up for depression in VA, largely due to measurement challenges. This study uses longitudinal electronic measures to assess receipt of follow-up visits, and of a minimal course of treatment among women Veterans compared to men.

Methods:
Using the VHA National Patient Care Database, Corporate Data Warehouse and Pharmacy Benefits Management databases from fiscal year 2007, we created a national cohort of all Veterans in nine geographically diverse VISNs with a new episode of depression. We used longitudinal electronic measures to assess for a minimal number of depression-related follow-up visits, and for receipt of minimum antidepressant medications. We defined follow-up as > = 3 mental health specialty (MHS), or psychotherapy, or primary care visits with ICD-9 diagnoses for depression within 180 days of a new episode. We defined the outcome minimal depression treatment course as > = 4 MHS visits, or > = 3 psychotherapy visits, or > = 60 days of anti-depressant medications in the succeeding year. We used multivariate logistic regression to test predictors of outcomes by gender, controlling for age and care location (VA medical center vs. community-based outpatient clinic).

Results:
Of the total number of Veterans identified with a new episode of depression 2,456 (9.17%) were female and 24,327 (90.83%) were male. In multivariate analyses women had 11.48% lower odds of receiving minimum follow-up at 180 days (OR 0.89, p-value < 0.05), and 0.18% lower odds of receiving minimal treatment for depression (OR 0.99, p-value = 0.976) compared to men, adjusted for model covariates. Age and location of treatment were significant covariates.

Implications:
While women received fewer follow-up visits in early depression treatment than men, they had similar rates of minimal depression treatment in the succeeding year.

Impacts:
These results suggest that gender equivalence in receiving minimal depression treatment was achieved in the nine VISNs we studied. The lower achievement of minimum follow-up among women may reflect greater barriers to in-person care. These results suggest opportunities for achieving treatment benchmarks that reflect more than minimal care.