Anxiety/Depression Diagnoses and Antidepressant Prescribing Patterns by Primary Care and Psychiatric Specialties, NAMCS 1995- 2003 Coauthors: Isabel Lagomasino,

Slides:

Advertisements

Similar presentations

1 Physicians Involved in the Care of Patients with Recently Diagnosed Cancer CanCORS Provider Composition Writing Group Academy Health Annual Research.

Advertisements

Adherence to Antidepressant Medications Among Health Plan Members Diagnosed with Major Depression Ayse Akincigil, John R. Bowblis, Carrie Levin, James.

Best Practices in Mental Health Services in Nursing Homes Steve Bartels, MD, MS President, American Association for Geriatric Psychiatry.

Do Primary Care Physicians Treating Minority Patients Report Greater Problems Delivering Quality Care? 1 A New Perspective on Racial and Ethnic Disparities.

Psychological Distress and Timely Use of Routine Care: The Importance of Having Health Insurance and a Usual Source of Care among Women with Children Whitney.

”Forensic psychiatric evaluations concerning mentally ill, non-psychotic offenders* in 2003 and 2008 at 4 regional centers in Denmark – development, differences.

NCHS Data – Strengths and Weaknesses from the NHLBI Perspective Paul Sorlie, Ph.D. Chief, Epidemiology Branch National Heart, Lung, and Blood Institute.

Journal Club Alcohol, Other Drugs, and Health: Current Evidence November-December 2007.

Printed by Asthma in Women of Color and/or Low Income Noreen M. Clark, PhD, Molly Gong, MD, Sijian Wang, MS, Melissa Valerio, MPH,

Prevalence of Predictors of Antidepressant Prescribing in Nursing Home Residents in the United States Swapna U. Karkare, MS, Sandipan Bhattacharjee, MS,

Electronic Medical Record Use and the Quality of Care in Physician Offices National Conference on Health Statistics August 17, 2010 Chun-Ju (Janey) Hsiao,

Physician Acceptance of New Medicaid Patients by State in 2011 Sandra Decker, Ph.D. National Center for Health Statistics NCHS National.

Frequency of Asthma Education in Primary Care for the Years Marquise Lee, MSCR 1, Kevin Cross, PharmD, MSCR 1, Wan Yu Yang, MSCR 1, Michael Jiroutek,

Trends in Health and Aging Major Trends and Patterns in Health and Aging July 2007.

Medicare Managed Care and Primary Care Quality: Examining Racial/Ethnic Effects across States Jayasree Basu, Ph.D. AHRQ 2009 Annual Conference.

Differences in Patterns of Impairment, Psychiatric Comorbidity and Headache Beliefs in Migraine and Chronic Tension-type Headache Kathleen M. Romanek M.S.,

Virginia Health Care Foundation’s Mental Health Roundtable

Racial Differences in Quality of Care for Bipolar Disorder Center for Health Equity Research and Promotion Departments of Medicine and Psychiatry, University.

The Impact of National Health Reform on Adults with Mental Disorders Rachel L. Garfield, Ph.D. Department of Health Policy & Management, University of.

NIDA Grants: U10DA015831, K24DA022288, U10DA020024, K23DA022297, U10DA Predictors of Outcome in the Multi-Site CTN Prescription Opioid Addiction.

Informing Public Policy to Address Health Care Disparities Boisey Barnes, MD, F.A.C.C. Founding Member and Trustee Association of Black Cardiologists.

Characteristics of Patients Using Extreme Opioid Dosages in the Treatment of Chronic Low Back Pain In this sample of 204 participants, 70% were female,

The Effect of Quality Improvement on Racial Disparities in Diabetes Care Thomas D. Sequist, MD MPH Alyce S. Adams, PhD Fang Zhang, MS Dennis Ross-Degnan,

Background Development of Anxiety Among Depressed Veterans After Antidepressant Usage Zhiguo Li, Paul Pfeiffer, Katherine Hoggatt, Kara Zivin, Karen Downing.

Washington D.C., USA, JULY Rulin C. Hechter 1 MD,PhD Jean Q. Wang 1 PhD Margo A. Sidell 1 ScD William J. Towner 2 MD 1 Dept.

Disparities in the Adequacy of Depression Treatment in the United States Jeffrey S. Harman, Ph.D. University of Florida Mark J. Edlund, M.D., Ph.D. John.

Effects of Pediatric Asthma Education on Hospitalizations and Emergency Department Visits: A Meta-Analysis June 3, 2007 Janet M. Coffman, PhD, Michael.

Richard Feng, Melanie Thomas, Connie Chen, James Dilley, Thao Tran, Christina Mangurian University of California, San Francisco and San Francisco General.

Women’s health: Data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) Esther.

Lisa Raiz, William Hayes, Keith Kilty, Tom Gregoire, Christopher Holloman Ohio Employer and Ohio Family Health Research Conference July 29, 2011.

Impact of Restrictive State Policies on Utilization and Expenditures in the Medicaid Program Roberto Vargas, MD, MPH 1,2 Carole Gresenz, PhD 2 Jessie Riposo,

Disparities Within and Between Hospitals for Inpatient Quality of Care: Targeting Resources to Close the Gap Romana Hasnain-Wynia, PhD Director, Center.

Private Hospitals and the Treatment of Severe Mental Illness: The Role of the Emergency Department Presented by: Richard C. Lindrooth, Ph.D. Medical University.

Washington D.C., USA, July 2012www.aids2012.org Collaborative HIV/AIDS Mental Health Project (CHAMP) Susan Reif, PhD, LCSW Center for Health Policy.

Copyright restrictions may apply Predictive Values of Psychiatric Symptoms for Internet Addiction in Adolescents: A 2-Year Prospective Study Ko C-H, Yen.

Positive and Negative Affect and Health in Lung Cancer Patients Jameson K. Hirsch, Ph.D. 1,2, H. Mason 1, & Paul R. Duberstein, Ph.D. 2 Department of Psychology,

Physician Practice Style and Barriers to Referral: Los Angeles Women’s Health Study Danielle Rose Ash, PhD VA HSR&D/Greater Los Angeles Care System Co-Authors:

Depression Care Management Lessons from Project IMPACT _____________________________________________________ Jürgen Unützer, MD, MPH Professor and Vice.

How Much Choice Do Seniors Want?: Survey Results on the Medicare Prescription Drug Benefit Janet Cummings Link* Thomas Rice* Yaniv Hanoch** *Department.

Racial Disparities in Primary Care and Utilization of Health Services at the End-of-Life Andrea Kronman, MD Boston University School of Medicine.

Racial/Ethnic Disparities in Quality of Ambulatory Care for Chronic Physical Health Conditions: T he effects of physician and care setting characteristics.

Behavioral Health Integration

® Changes in Opioid Use Over One Year in Patients with Chronic Low Back Pain Alejandra Garza, Gerald Kizerian, PhD, Sandra Burge, PhD The University of.

Racial/Ethnic Differences in the Use of Health Information to Self-Advocate During the Medical Encounter: Is Having Health Information Enough? Jacqueline.

Addressing Racial/Ethnic Differences in ADHD Diagnosis and Treatment Among Medicaid-insured Youth in California Dinci Pennap, MPH, 1 Mehmet Burcu, MS,

The Role of Residential Segregation in Disparity Research: A Case Example of ADHD Diagnosis and Treatment Dinci Pennap, MPH, 1 Mehmet Burcu, MS, 1 Daniel.

Study Design & Population A retrospective cohort design was applied to the Medicaid administrative claims data of youth continuously enrolled in a Mid-Atlantic.

Smoking and Mental Health Problems in Treatment-Seeking University Students Eric Heiligenstein, M.D. University of Wisconsin-Madison Health Services Stevens.

Racial/Ethnic Differences in Pediatric Antipsychotic Use by FDA Labeled/Off-label Status MARYLAND CENTER FOR EXCELLENCE IN REGULATORY SCIENCE & INNOVATION.

Do State Parity Laws Differentially Impact Low Income or High Need Groups? Colleen L. Barry, Ph.D. Susan H. Busch, Ph.D. Yale School of Medicine June 2006.

ALDH2 and Conduct Disorder Mediate Ethnicity and Alcohol Dependence in Chinese-, Korean-, and White-American College Students S.E. Luczak, T.A.R. Cook,

PHQ-9 Severity and Screening Tests Predictive of Remission Outcomes at Six Months Kurt B. Angstman, MS MD Associate Professor John M. Wilkinson Assistant.

Clare Meernik, MPH 1 ; Anna McCullough, MSW, MSPH, CTTS 1 ; Leah Ranney, PhD 1 ; Barbara Walsh 2 ; Adam O. Goldstein, MD, MPH 1 Predictors of Quit for.

The Geography of Viral Hepatitis C In Texas, Mara Hedrich

Trends in Access to Substance Abuse Treatment for Women and Men: Jeanne C. Marsh, PhD, Hee-Choon Shin, PhD, Dingcai Cao, PhD University of Chicago.

Arnold School of Public Health Health Services Policy and Management 1 Women’s Cancer Screening Services Utilization Versus Their Insurance Source Presenter:

SSDS Inc. Intentional injury in the U.S. Army: Is a college education the answer? Nicole S. Bell, ScD, MPH Thomas C. Harford, PhD Social Sectors Development.

1 Ethnic Disparities in Place of Service Among Medicaid Beneficiaries with Mental Illnesses PhD Funded by:RWJ Foundation.

Health Care Utilization and Costs of Depressed Veterans with Comorbid Posttraumatic Stress Disorder (PTSD) APHA Annual Meeting 2007 Domin Chan, MHS, PhD.

MAKING HEALTH CARE AFFORDABLE: PRESERVING ACCESS AND IMPROVING VALUE

Mental and Behavioral Health Services

Disparities in process and outcome measures among adults with persistent asthma David M. Mosen, PhD, MPH; Michael Schatz, MD, MS; Rachel Gold, PhD; Winston.

Ana Progovac, PhD1,2,3 Benjamin Lê Cook, PhD MPH 1,2

Resolving outcome disparities in depression for minority primary care patients with collaborative care management Kurt B. Angstman, MS MD Associate Professor.

Early Diagnosis of ASD In a Community Sample: Who Refers and Why?

White River Junction, Vermont VA Outcomes Group REAP

University of Massachusetts Medical School

Department of Health Management and Informatics

Early Diagnosis of ASD In a Community Sample: Who Refers and Why?

Primary care physicians visited chiefly by black patients were more likely to report they were unable to provide high-quality care to all their patients.

Presentation transcript:

Anxiety/Depression Diagnoses and Antidepressant Prescribing Patterns by Primary Care and Psychiatric Specialties, NAMCS Coauthors: Isabel Lagomasino, M.D., Jeanne Miranda, Ph.D. Supported by a grant from the MacArthur Foundation

Background Rates of diagnosis and treatment for depression/anxiety low among ethnic minorities (Skaer et al. 2000; Olfson et al. 2002). Improvements in depression care for minorities may be due to national efforts in primary care settings. Kessler et al fold increase in MH treatment in the general medical sector, 2.2 fold in psychiatric settings. Pincus et al. 1998; Olfson et al much of the increase in antidepressant prescriptions has been among psychiatrists.

Research Questions and Hypotheses No previous studies have simultaneously examined the roles of physician specialty and patient race/ethnicity in diagnoses and treatment. Examine trends in diagnoses and treatment for depressive and anxiety, by psychiatrists and primary care physicians, for white, Hispanic, and African-American patients. Hypotheses: 1) depression/anxiety diagnoses and treatment will increase over time and 2) ethnic differences in diagnoses and treatment will persist but be reduced over time, especially in the primary care sector.

NAMCS Office-based outpatient visits for psychiatric specialties (n=10747) and primary care (n=61516). Outcomes: depression/anxiety diagnoses, antidepressant prescriptions Predictors: race/ethnicity (white, black, Hispanic), gender, age, source of payment (private insurance, Medicare, Medicaid/workers’ compensation, self- pay/charity care), time period ( , , ), depression/anxiety reason for visit. Analysis: Multivariate logistic regression, main effects and interactions, standardized predictions.

ORs for predictors of depression/anxiety diagnosis OR (95% CI)PsychiatryPrimary care Race/ethnicity (vs white) Black0.62 (0.45, 0.86)**0.55 (0.43, 0.70)*** Hispanic0.81 (0.59, 1.11)0.57 (0.44, 0.75)*** Age1.01 (1.01, 1.02)***1.00 (1.00, 1.01) Female1.36 (1.16, 1.59)***1.19 (1.08, 1.31)*** Expected payment (vs priv. ins.) Medicare0.48 (0.39, 0.60)***0.96 (0.80, 1.16) Medicaid/Worker’s comp.0.45 (0.34, 0.58)***1.20 (0.94, 1.54) Self pay/charity care0.66 (0.51,.84)***1.34 (1.09, 1.64)** Time period (vs ) (0.87, 1.65)0.99 (0.84, 1.17) (0.98, 1.88)~1.29 (1.10, 1.52)** Depression/anxiety visit4.31 (3.48, 5.34)***24.6 (21.9,27.7)***

ORs for predictors of antidepressant prescriptions OR (95% CI)PsychiatryPrimary care Race/ethnicity (vs white) Black0.78 (0.57, 1.07)0.57 (0.47, 0.68)*** Hispanic0.98 (0.71, 1.34)0.57 (0.41, 0.80)** Age1.00 (1.00, 1.01)*1.01 (1.00, 1.01)** Female1.15 (0.95, 1.39)1.30 (1.18, 1.43)*** Expected payment (vs priv. ins.) Medicare0.73 (0.62, 0.87)***1.08 (0.94, 1.23) Medicaid/Worker’s comp.0.73 (0.58, 0.94)*1.19 (0.97, 1.46)~ Self pay/charity care0.47 (0.38, 0.59)***0.85 (0.68, 1.05) Time period (vs ) (1.18, 2.15)**1.30 (1.09, 1.54)** (1.12, 1.98)**1.59 (1.38, 1.84)*** Depression/anxiety visit1.90 (1.55, 2.32)***9.30 (8.25,10.5)***

Primary care visits involving black and Hispanic patients, and psychiatric visits involving black patients, are significantly less likely to result in a diagnosis of depression or anxiety. Psychiatric specialists are equally likely to prescribe antidepressants to black or Hispanic patients (as compared with whites), but primary care office visits involving black or Hispanic patients are less likely to result in a prescription for antidepressants. These differences remain remarkably consistent over time. Conclusions

Significance/Implications for Policy Differences in rates of diagnoses and treatment may be a consequence of physician knowledge and ability to identify the disorder, differences in the pathways to care for psychiatric specialties versus primary care, and/or differences in patient preferences. Although interventions aimed at improving depression identification and care in primary care may help to reduce disparities, other factors outside the medical care setting may also need to be targeted.