Potentially inappropriate management of depressive symptoms among Ontario home care clients.
OBJECTIVE
To examine the prevalence and correlates of potentially inappropriate pharmacotherapy (including potential under-treatment) for depression in adult home care clients.


METHODS
A cross-sectional study of clients receiving services from Community Care Access Centres in Ontario. Three thousand three hundred and twenty-one clients were assessed with the Resident Assessment Instrument for Home Care (RAI-HC). A score of 3 or greater on the Depression Rating Scale (DRS), a validated scale embedded within the RAI-HC, indicates the presence of symptoms of depression. Medications listed on the RAI-HC were used to categorize treatment into two groups: potentially appropriate and potentially inappropriate antidepressant drug therapy. Adjusted logistic regression models were used to explore relevant predictors of potentially inappropriate pharmacotherapy.


RESULTS
12.5% (n=414) of clients had symptoms of depression and 17% received an appropriate antidepressant. Over half of clients (64.5%) received potentially inappropriate pharmacotherapy (including potential under-treatment). Age 75 years or older, higher levels of caregiver stress and the presence of greater comorbidity were associated with a higher risk of potentially inappropriate pharmacotherapy in multivariate analyses. Documentation of any psychiatric diagnosis on the RAI-HC and receiving more medications were significantly associated with a greater likelihood of appropriate drug treatment.


CONCLUSIONS
Most clients with significant depressive symptoms were not receiving appropriate pharmacotherapy. Having a documented diagnosis of a psychiatric condition on the RAI-HC predicted appropriate pharmacotherapy. By increasing recognition of psychiatric conditions, the use of standardized, comprehensive assessment instruments in home care may represent an opportunity to improve mental health care in these settings.
Dalby
Dawn M
DM
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada. ddalby@wlu.ca
Hirdes
John P
JP
Hogan
David B
DB
Patten
Scott B
SB
Beck
Cynthia A
CA
Rabinowitz
Terry
T
Maxwell
Colleen J
CJ
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003156:Community Mental Health Services / Q000592:standards*; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards; D004363:Drug Utilization / Q000592:standards; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
D000928:Antidepressive Agents