Depression care and treatment in a chronically ill Medicare population

Objective: The purpose of this study is to examine depression care among chronically ill Medicare Advantage beneficiaries.

Methods: This study includes 5898 Medicare Advantage members with a depression diagnosis enrolled between 2008 and 2010 in a care management program. Two depression care indicators were created: (a) any depression care (≥ 1 antidepressant prescription or ≥ 1 specialty mental health visit) and (b) among those receiving any depression care, those receiving an antidepressant prescription for ≥ 90 days or ≥ 2 specialty visits. Multivariable analysis using logistic regression was used to examine correlates of depression care.

Results: Among those <65 years old, 72% received any depression care with 75% receiving ≥ 90 days of an antidepressant and/or ≥ 2 specialty visits. Among ≥ 65 years old, 65% received any depression care with 67% receiving ≥ 90 days of an antidepressant and/or ≥ 2 specialty visits. For both age groups, female gender, medical comorbidities and dual eligibility were positively associated with an antidepressant prescription. In the older group, female gender was positively associated with at least a 90-day supply of an antidepressant prescription, while substance use disorders were negatively associated with receiving a minimum of 90 days of an antidepressant. Regional differences and certain psychiatric comorbidities were also associated with receiving depression care.

Conclusion: Two thirds of the depressed patients in this Medicare Advantage population received depression care. Further studies are needed to examine the effects of quality improvement efforts in the context of care management programs for chronically ill older adults.