抑郁症青年的抗抑郁治疗质量:对国家医疗补助患者的评价。

IF 9.2 1区 医学 Q1 PEDIATRICS
Cynthia A Fontanella, J Madison Hyer, Danielle L Steelesmith, John V Campo, Mary A Fristad, Jeffrey A Bridge, Susan dosReis, Guy N Brock, Mark Olfson
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引用次数: 0

摘要

目的:研究开始接受抑郁症治疗的青少年对抗抑郁药管理质量措施的依从率,并确定与依从性相关的人口统计学、临床和县级因素。方法:本回顾性队列研究使用了2016年1月1日至2019年2月28日期间9至24岁青少年新发重度抑郁症的国家医疗补助数据(N= 196364)。质量指标来源于三个健康有效性数据和信息集(HEDIS)质量指标:1)急性期,持续服用抗抑郁药3个月的青少年百分比;2)延续期,持续服用抗抑郁药6个月的青少年百分比;3)随访接触,在急性期接受至少3次随访的青少年的百分比。稳健泊松回归检验了人口统计学、临床和县级因素与依从性之间的关系。结果:约一半(49.6%)的患者坚持急性期药物治疗,55.2%的患者至少有3次随访;只有26.5%达到了延续阶段的指标。年龄较大,少数种族/民族地位和物质使用障碍与较低的依从性相关。相比之下,患有慢性疾病、以前使用过其他精神药物或寄养的青少年的依从性更高。结论:在接受抗抑郁药物治疗的青少年抑郁症患者中,有相当大比例的患者没有得到符合质量标准的护理,这在年龄较大的青少年和少数种族/民族中存在显著差异。需要有针对性的质量改进工作,以缩小依从性和后续护理方面的差距,特别是针对服务不足的人群,并促进更一致、更公平的治疗提供。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antidepressant Treatment Quality of Depressed Youth: A National Evaluation of Medicaid Patients.

Objective: To examine rates of adherence to antidepressant management quality measures among youth initiating treatment for depression, and to identify demographic, clinical, and county-level factors associated with adherence.

Method: This retrospective cohort study used US national Medicaid data for youth 9 to 24 years of age who were prescribed antidepressants for a new episode of major depression from January 1, 2016, to February 28, 2019 (N = 196,364). Quality measures were derived from 3 Health Effectiveness Data and Information Set (HEDIS) quality measures: (1) acute phase, the percentage of youth who remained on antidepressants for 3 months; (2) continuation phase, the percentage of youth who remained on antidepressants for 6 months; and (3) follow-up contacts, the percentage of youth who received at least 3 follow-up visits during the acute phase. Robust Poisson regression examined associations between demographic, clinical, and county-level factors and adherence.

Results: Approximately half (49.6%) of the youth were adherent to acute-phase medication management and 55.2% had at least 3 follow-up visits; only 26.5% met continuation phase metrics. Older age, minoritized racial/ethnic status, and substance use disorders were associated with lower adherence. In contrast, youth with chronic medical conditions, prior use of other psychotropic medications, or in foster care had higher adherence.

Conclusion: A substantial proportion of youth with depression receiving antidepressant treatment do not receive care aligned with quality measures, with notable disparities among older youth and racial/ethnic minorities. Targeted quality improvement efforts are needed to close gaps in adherence and follow-up care, particularly for underserved populations, and to promote more consistent, equitable treatment delivery.

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来源期刊
CiteScore
21.00
自引率
1.50%
发文量
1383
审稿时长
53 days
期刊介绍: The Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP) is dedicated to advancing the field of child and adolescent psychiatry through the publication of original research and papers of theoretical, scientific, and clinical significance. Our primary focus is on the mental health of children, adolescents, and families. We welcome unpublished manuscripts that explore various perspectives, ranging from genetic, epidemiological, neurobiological, and psychopathological research, to cognitive, behavioral, psychodynamic, and other psychotherapeutic investigations. We also encourage submissions that delve into parent-child, interpersonal, and family research, as well as clinical and empirical studies conducted in inpatient, outpatient, consultation-liaison, and school-based settings. In addition to publishing research, we aim to promote the well-being of children and families by featuring scholarly papers on topics such as health policy, legislation, advocacy, culture, society, and service provision in relation to mental health. At JAACAP, we strive to foster collaboration and dialogue among researchers, clinicians, and policy-makers in order to enhance our understanding and approach to child and adolescent mental health.
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