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Psychiatric Briefs

Prim Care Companion J Clin Psychiatry 2007;9:400-403
Objective: The investigators sought to ascertain the relationships between guideline-concordant pharmacotherapy for depression and the use of health services in the year following diagnosis. 

Method: Quebec drug plans between 1999 and 2002 were investigated in a population-based, retrospective cohort study. Beneficiaries aged 18 to 64 years who were newly diagnosed with an episode of depression by primary care physicians and psychiatrists between October 1, 2000, and March 31, 2001, and who made at least 1 psychotropic pharmacy claim within 31 days of diagnosis were included. Guideline concordance was defined as the receipt of recommended medication, starting dosage, and treatment duration as defined by the Canadian Network for Mood and Anxiety Treatments guidelines. The use of ambulatory (number of visits to prescribing physician, other physicians, or emergency departments) and inpatient (hospitalization) services were measured outcomes. 

Results: Study criteria were met by 2742 patients (mean age of 42 years; 64% female). An antidepressant was dispensed to 2047 patients (75%). Of these, 1958 (71%) received a recommended first-line medication, 1297 (63%) received a recommended starting dosage, and 304 (15%) received a recommended duration. Only 8% received appropriate treatment according to the guidelines; 21% received benzodiazepines instead of antidepressants. Two median visits (interquartile range [IQR], 1–3) were made to prescribing physicians, none (IQR, 0–1) to other physicians, and none (IQR, 0–0) to emergency departments; 497 patients (18%) were hospitalized. Recommended first-line medication, dosage, and duration were associated with more prescribing physician visits in separate multivariate models for repeated measures, and the odds of hospitalization were lowered by recommended first-line medication. 

Conclusion: Guideline concordance was related to more visits to prescribing physicians and lower odds of hospitalization.