Innovations in Pharmacological Treatment of Major Depressive Disorder and Associated Patient Outcomes.

Antidepressant;Major Depressive Disorder (MDD);Adherence;Health Expenditure;Employment Duration;Quality of Life;Public Health;Social Sciences;Health Services Organization and Policy and Social and Adm

Lin, Hsien-ChangSmith, Dean G. ;

University of Michigan

关键词: Antidepressant;    Major Depressive Disorder (MDD);    Adherence;    Health Expenditure;    Employment Duration;    Quality of Life;    Public Health;    Social Sciences;    Health Services Organization and Policy and Social and Adm;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/77819/hsclin_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

The overarching topic of this research was to study the adoption and utilization of innovative antidepressants and its associations with patient labor market and health outcomes. The differences in adoption across patient and physician characteristics, geographic regions, insurance status, and other related factors in the United States needed further research. The adoption of SSRIs/SNRIs is characterized by the prescription volume and reflected in physician’s adherence to practice guidelines and patient’s adherence to medications. Therefore, the objective of this research was to try to understand the pattern of prescribing and use of SSRI/SNRI medications for patients with major depressive disorder (MDD) and the process of its adoption, and patients adherence to these medications. In addition, patient outcomes such as employment duration and quality of life associated with the use of SSRI/SNRI antidepressants were studied. This research used the 1993-2007 National Ambulatory Medical Care Survey (NAMCS) and the 2000-2007 Medical Expenditure Panel Survey (MEPS), two national surveys, to explore these research objectives. A two-stage Heckman selection model along with multinomial logistic regression models were used to capture the two-stage nature of SSRI/SNRI prescription and use. In addition, linear regression and two-part models were used to examine MDD patient’s medication adherence and associated health care expenditures. Finally, proportional hazard models were implemented to explore antidepressant use and patient’s labor market participation, and linear regression models were used to examine associated patient quality of life.We observed an association between sociological factors and physician’s innovative antidepressant prescribing patterns. Differences in antidepressant adherence and health care spending across patient factors were revealed. In addition, patient health status and quality of life varied across patient factors, in which patient utilization of innovative antidepressants were found to have positive associations with patient mental health status. Differences in antidepressant adherence and health care spending across patient factors could have important policy implications for drug formularies and reduction of health disparities. Effective policy interventions are needed for improving medication adherence and accommodating patient factors. Tailoring drug formularies and prescription drug benefit design within health insurance, and adjusting patient payment schemes for antidepressants are strongly suggested based on this research.