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Quality of Care for Medicaid-Covered Youth Treated With Antidepressant Therapy
Laura P. Richardson, MD, MPH;
David DiGiuseppe, MSc;
Dimitri A. Christakis, MD, MPH;
Elizabeth McCauley, PhD;
Wayne Katon, MD
Arch Gen Psychiatry. 2004;61:475-480.
Background Although antidepressant use has increased in pediatric populations, few studies have addressed the quality of follow-up care or duration of treatment for depressed youth.
Objective To evaluate the quality of care for antidepressant-treated youth, using the Health Plan Employer Data and Information Set guidelines ( 3 visits in the 3 months after a new antidepressant prescription fill and continuation of antidepressant use at 3 and 6 months) as a benchmark.
Design Administrative records were examined for 1205 Medicaid-covered youth (aged 5-18 years) who presented with a "new episode" of depression in 1998. Statistics were generated to describe the number of follow-up visits and duration of treatment within 6 months of first prescription fill.
Results A total of 507 (42.1%) youth with new episodes of depression were treated with antidepressants. Selective serotonin reuptake inhibitors accounted for 80.9% of prescriptions. Twenty-eight percent (28.1%) of youth with an antidepressant fill had 3 or more follow-up visits in the subsequent 3 months; however, an additional 29.2% had no further provider visits. Selective serotonin reuptake inhibitors were continued by 46.6% of treated youth at 3 months and by 26.3% at 6 months.
Conclusions Many antidepressant-treated youth do not receive adequate follow-up or duration of treatment. Future studies should address reasons for poor follow-up and methods to improve monitoring for these youth.
From the Child Health Institute (Drs Richardson, Christakis, and McCauley and Mr DiGiuseppe) and Departments of Pediatrics (Drs Richardson and Christakis) and Psychiatry (Drs McCauley and Katon), University of Washington, Seattle.
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