title: Inadequate follow-up care for depression and its impact on antidepressant treatment duration among veterans with and without diabetes mellitus in the Veterans Health Administration.
abstract: OBJECTIVE
  Our objective was to describe the adequacy of follow-up care for depression and its association with antidepressant treatment duration among veterans with and without diabetes mellitus (DM).
  
  
  METHODS
  This was a retrospective study (1997-2005) of 2178 veterans (33% with DM) in a Midwestern Veterans Health Administration facility who had a new episode of unipolar depression. Adequate follow-up care was defined by a health care visit within 7 and 14 days, and >/=3 visits following antidepressant treatment initiation. Adequate treatment duration was defined by a medication possession ratio of >/=80%. Multivariate logistic regression was used to calculate odds ratios (ORs) adjusted for demographic, clinical and health care utilization characteristics.
  
  
  RESULTS
  Only 27% received >/=3 follow-up visits within 12 weeks, and <23% received follow-up within 2 weeks of antidepressant initiation. Subjects with DM were 1.36-fold more likely [95% confidence interval (95% CI)=1.05-1.75] to have received >/=3 visits but were similarly likely to have received follow-up within 7 days (OR=1.02; 95% CI=0.74-1.41) or 14 days (OR=1.08; 95% CI=0.83-1.40) of antidepressant initiation. Adequate follow-up care was the most important predictor of adequate treatment duration (OR=2.10; 95% CI=1.54-2.88).
  
  
  CONCLUSIONS
  DM had little influence on the adequacy of follow-up care for depression, with few exceptions. Follow-up care for depression is underutilized and has a significant impact on antidepressant treatment duration. Strategies to more effectively manage depression treatment are required.
authors.affiliation: Roudebush VAMC HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Indianapolis, IN 46202, USA. lj2@iupui.edu
authors.forename: Laura E
authors.initials: LE
authors.lastname: Jones
authors.forename: Carolyn
authors.initials: C
authors.lastname: Turvey
authors.forename: Caroline
authors.initials: C
authors.lastname: Carney-Doebbeling
mesh_terms: D000328:Adult; D000359:Aftercare / Q000592:standards*; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003710:Demography; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents