title: Comparing the quality of antidepressant pharmacotherapy in the Department of Veterans Affairs and the private sector.
abstract: OBJECTIVE
  Comparing quality of care between large health care systems is important for health systems management. This study compared measures of the quality of pharmacotherapy for patients with major depression across a sample of patients from the Department of Veterans Affairs (VA) and the private sector.
  
  
  METHODS
  In this observational study, all patients who were given a new prescription for an antidepressant and a diagnosis of major depression in the VA during fiscal year 2000 were identified by using administrative data (N=27,713). In the private sector, a similar sample of patients were identified by using Medstat's MarketScan database (N=4,852). For both groups, measures of the quality of antidepressant pharmacotherapy were constructed. These measures were compared across the two groups by using logistic regression models. Controls for age, gender, comorbid disorders, and initial antidepressant drug prescribed were included in some models.
  
  
  RESULTS
  Although the populations had different demographic and clinical characteristics, differences in the quality measures between the two systems were few, with the VA slightly outperforming the private sector in the prescription of antidepressants during the acute phase of treatment, the first 84 days (84.7 compared with 81 percent) and during the maintenance phase of treatment, the first 181 days (53.9 compared with 50.9 percent). Patient characteristics that were associated with quality measures included being older, being female, and having a comorbid diagnosis of substance use disorder, bipolar disorder, or anxiety or adjustment disorder.
  
  
  CONCLUSIONS
  Both systems had relatively high rates of adherence to pharmacotherapy guidelines. Even though the populations in the two systems were different, adjusting the analyses for clinical characteristics did little to change the measured differences between the two systems.
authors.affiliation: Department of Health Policy, Yale School of Medicine, New Haven, Connecticut 06520-8034, USA. susan.busch@yale.edu
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Leslie
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004358:Drug Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019370:Observation; D017149:Private Sector; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000928:Antidepressive Agents