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;
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.
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).
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.
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.
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.