Merrick Elizabeth L, Hodgkin Dominic, Panas Lee, Soumerai Stephen B, Ritter Grant
Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
J Pharm Health Serv Res. 2012 Mar 1;3(1):11-16. doi: 10.1111/j.1759-8893.2011.00068.x. Epub 2011 Oct 19.
The objective was to explore whether prescribing variation is associated with duration of antidepressant use during the acute phase of treatment. Improving quality of care and increasing the extent to which treatment is patient-centered and customized are interrelated goals. Prescribing variation may be considered a marker of customization, and could be associated with better antidepressant treatment adherence. METHODS: A cross-sectional secondary data analysis examining the association between providers' antidepressant prescribing variation and patient continuity of antidepressant treatment. The data source was two states' Medicaid claims for dual-eligible Medicaid/Medicare patients. The sample included 383 patients with new episodes of antidepressant treatment, representing 70 providers with at least four patients in the sample. We tested two alternate measures of prescribing concentration: 1) share of prescriber's initial antidepressant prescribing accounted for by the two most common regimens, and 2) Herfindahl index. The HEDIS performance measure of effective acute-phase treatment (at least 84 out of 114 days with antidepressant) was the dependent variable. KEY FINDINGS: In multivariate analyses, the concentration measure based on the top two regimens was significant and inversely related to duration adequacy (p <.05). The Herfindahl index measure showed a trend towards a similar inverse relationship (p<.10). CONCLUSIONS: The findings provide some support for the hypothesized relationship between prescribing variation and adequate antidepressant treatment duration during the acute phase of treatment. Future work with more detailed, clinical longitudinal data could extend this inquiry to better understand the causal mechanisms using a more direct measure of customized care.
探讨在治疗急性期，处方差异是否与抗抑郁药使用时长相关。改善医疗质量以及提高治疗以患者为中心和个性化的程度是相互关联的目标。处方差异可被视为个性化的一个标志，并且可能与更好的抗抑郁治疗依从性相关。方法：进行一项横断面二次数据分析，考察医疗服务提供者的抗抑郁药处方差异与患者抗抑郁治疗连续性之间的关联。数据来源是两个州针对双重资格的医疗补助/医疗保险患者的医疗补助索赔。样本包括383例有抗抑郁治疗新发作的患者，代表70名医疗服务提供者，样本中每位提供者至少有4例患者。我们测试了两种处方集中度的替代指标：1）两种最常见治疗方案在开处方者初始抗抑郁药处方中所占的比例，以及2）赫芬达尔指数。有效急性期治疗（114天中至少84天使用抗抑郁药）的医疗效果数据和信息集（HEDIS）绩效指标是因变量。主要发现：在多变量分析中，基于前两种治疗方案的集中度指标具有显著性，且与治疗时长充足性呈负相关（p<.05）。赫芬达尔指数指标显示出类似的负相关趋势（p<.10）。结论：这些发现为治疗急性期处方差异与充足的抗抑郁治疗时长之间的假设关系提供了一些支持。未来使用更详细的临床纵向数据开展的研究可以扩展这一探究，以使用更直接的个性化护理指标更好地理解因果机制。
