Geriatric depression, antidepressant treatment, and healthcare utilization in a health maintenance organization.
OBJECTIVE
To assess the separate effects of depressive symptoms and antidepressant treatment on healthcare utilization and cost.


METHODS
Social Health Maintenance Organization (HMO) at HealthPartners in Minnesota.


METHODS
Geriatric Social HMO enrollees were screened for depressive symptoms using the 30-item Geriatric Depression Scale. A stratified sample was created, composed of geriatric enrollees with depressive symptoms, with antidepressant prescriptions, or with neither (n = 516).


METHODS
Regression analyses were conducted with separate equations for utilization and charge outcome variables, both outpatient and inpatient (log-transformed). The Charlson Comorbidity Index, age, and gender served as covariates.


METHODS
Depressive symptoms were identified through the Diagnostic Interview Schedule. Antidepressant treatment was determined from the HMO pharmacy database.


RESULTS
Having depressive symptoms was associated with a 19 increase in the number of outpatient encounters and a 30 increase in total outpatient charges. Antidepressant treatment was associated with a 32 increase in total outpatient charges but was not significantly associated with number of outpatient encounters. Depressive symptoms and antidepressant therapy were not significantly associated with inpatient utilization or charges.


CONCLUSIONS
This study found that patients with depressive symptoms generated more outpatient health care and higher charges but not necessarily more inpatient care. Our findings suggest that programs targeted to geriatric patients whose depression is comorbid with other chronic medical conditions might be cost-effective and particularly appropriate for geriatric care.
Fischer
Lucy Rose
LR
HealthPartners Research Foundation, University of Minnesota, Minneapolis 55440, USA. lucy.r.fischer@healthpartners.com
Wei
Feifei
F
Rolnick
Sharon J
SJ
Jackson
Jody M
JM
Rush
William A
WA
Garrard
Judith M
JM
Nitz
Nicole M
NM
Luepke
Lori J
LJ
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics*; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D008910:Minnesota; D009819:Office Visits / Q000191:economics; D012044:Regression Analysis
D000928:Antidepressive Agents