Is customization in antidepressant prescribing associated with acute-phase treatment adherence?

Abstract

Objectives The objective of this study 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-centred 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 was carried out, examining the association between providers' antidepressant prescribing variation and patient continuity of antidepressant treatment. The data source was two states' Medicaid claims for dual-eligibility 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 alternative 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<0.05). The Herfindahl index measure showed a trend towards a similar inverse relationship (P<0.10). 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. © 2011 The Authors. JPHSR © 2011 Royal Pharmaceutical Society.