Impact of Medicare Part D on Antidepressant Treatment, Medication Choice, and Adherence Among Older Adults With Depression

被引:30
作者
Donohue, Julie M. [1 ,2 ,8 ]
Zhang, Yuting [1 ]
Men, Aiju
Perera, Subashan [3 ,4 ]
Lave, Judith R. [1 ]
Hanlon, Joseph T. [3 ,4 ,5 ,6 ,7 ]
Reynolds, Charles F. [2 ,8 ]
机构
[1] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA 15261 USA
[2] Univ Pittsburgh, Sch Med, Dept Psychiat, Pittsburgh, PA 15261 USA
[3] Univ Pittsburgh, Sch Med, Dept Geriatr Med, Pittsburgh, PA 15261 USA
[4] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
[5] Univ Pittsburgh, Sch Pharm, Dept Pharm & Therapeut, Pittsburgh, PA 15261 USA
[6] Univ Pittsburgh, Clin & Translat Sci Inst, Ctr Hlth Equ Res, Pittsburgh, PA 15261 USA
[7] Univ Pittsburgh, Ctr Geriatr Res Educ & Clin, Vet Affairs Pittsburgh Healthcare Syst, Pittsburgh, PA 15261 USA
[8] Univ Pittsburgh, Sch Med, Dept Neurol, Pittsburgh, PA 15261 USA
基金
美国国家卫生研究院; 美国医疗保健研究与质量局;
关键词
Adherence; depression; insurance coverage; medicare; MAJOR DEPRESSION; HEALTH-SERVICES; DRUG; SYMPTOMS; COST; NONADHERENCE; MORTALITY; NEEDS;
D O I
10.1097/JGP.0b013e3182051a9b
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives: Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice, and adherence. Design, Setting and Participants: Observational claims-based study of older adults with depression (ICD-9: 296.2, 296.3, 311, 300.4) continuously enrolled in a Medicare managed care plan between 2004 and 2007. Three groups with limited ($ 150 or $ 350 quarterly caps) or no drug coverage in 2004-2005 obtained Part D benefits in 2006. A comparison group had stable employer-sponsored coverage throughout. Measurements: Any antidepressant prescription fill, antidepressant choice (tricyclics or monoamine oxidase inhibitors versus newer antidepressants), and adherence (80% of days covered) in the first 6 months of treatment. Results: Part D was associated with increased odds of any antidepressant use among those who previously lacked coverage (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.41-1.85) but odds of use did not change among those with limited prior coverage. Use of older antidepressant agents did not change with Part D. All three groups whose coverage improved with Part D had significantly higher odds of 80% of days covered with an antidepressant (OR = 1.86 [95% CI: 1.44-2.39] for no coverage, 1.74 [95% CI: 1.25% 3.42] for $ 150 cap; and 1.19 [95% CI: 1.06-1.34] for the $ 350 cap groups). Conclusions: Medicare Part D was associated with improvements in antidepressant use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. (Am J Geriatr Psychiatry 2011; 19:989-997)
引用
收藏
页码:989 / 997
页数:9
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