HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in JABFM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Gill, J. M. Articles by Chen, Y. X. PubMed PubMed Citation Articles by Gill, J. M. Articles by Chen, Y. X. Social Bookmarking                      What's this?

Antidepressant Medication Use for Primary Care Patients with and without Medical Comorbidities: A National Electronic Health Record (EHR) Network Study

Delaware Valley Outcomes Research, Newark, DE (JMG, YXC)
Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA (JMG)
Department of Family Medicine, St. Francis Hospital, Wilmington, DE (JMG)
Departments of Family and Community Medicine and the Department of Psychiatry, University of Michigan, Ann Arbor (MSK)

Correspondence: Corresponding author: James M. Gill, MD, MPH, Delaware Valley Outcomes Research, 17 Henderson Hill Road, Newark, DE 19711 (E-mail: gillj{at}dvoresearch.com)

Background: Because comorbid depression can complicate medical conditions (eg, diabetes), physicians may treat depression more aggressively in patients who have these conditions. This study examined whether primary care physicians prescribe antidepressant medications more often and in higher doses for persons with medical comorbidities.

Methods: This secondary data analysis of electronic health record data was conducted in the Centricity Health Care User Research Network (CHURN), a national network of ambulatory practices that use a common outpatient electronic health record. Participants included 209 family medicine and general internal medicine providers in 40 primary care CHURN offices in 17 US states. Patients included adults with a new episode of depression that had been diagnosed during the period October 2006 through July 2007 (n = 1513). Prescription of antidepressant medication and doses of antidepressant medication were compared for patients with and without 6 comorbid conditions: diabetes, coronary heart disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, and cancer.

Results: 20.7% of patients had at least one medical comorbidity whereas 5.8% had multiple comorbidities. Overall, 77% of depressed patients were prescribed antidepressant medication. After controlling for age and sex, patients with multiple comorbidities were less likely to be prescribed medication (adjusted odds ratio, 0.58; 95% CI, 0.35–0.96), but there was no significant difference by individual comorbidities. Patients with cerebrovascular disease were less likely to be prescribed a full dose of medication (adjusted odds ratio, 0.26; 95% CI, 0.08–0.88), but there were no differences for other comorbidities or for multiple comorbidities, and there was no difference for any comorbidities in the prescription of minimally effective doses.

Conclusions: Patients with new episodes of depression who present to a primary care practice are not treated more aggressively if they have medical comorbidities. In fact, patients with multiple comorbidities are treated somewhat less aggressively.

Key Words: Practice-based Research • PBRN • Electronic Medical Records • Primary Health Care • Chronic Disease

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related articles in JABFM:

Guest Family Physician Commentaries

William J. Murdoch
JABFM 2010 23: 429-430. [Full Text]  

This article has been cited by other articles:

				W. J. Murdoch Guest Family Physician Commentaries J Am Board Fam Med, July 1, 2010; 23(4): 429 - 430. [Full Text] [PDF]