Using medical records to supplement a claims-based comparative effectiveness analysis of antidepressants.
OBJECTIVE
Because health insurance claims lack clinical information, comparative effectiveness research studies that rely on these data may be challenging to interpret and may result in biased inference. We conducted an exploratory study to determine if medical information contained in patient charts could offer clinical details that would assist in interpreting the results of a claims-based comparative effectiveness study of selective serotonin reuptake inhibitors (SSRIs).


METHODS
Retrospective review of 457 charts of patients initiating SSRI treatment. Descriptive data elements included patient diagnosis, symptoms of depressive and anxiety disorders, provider's assessment, and medication treatment and side effects.


RESULTS
Most subjects were excluded from the study because their charts were not accessible (58.7%), they did not have a follow-up visit (55.6%), providers could not be contacted (58.0%), or providers refused participation in the study (36.5%). Among those included in the study, most patients were noted to have depression, but most charts lacked information on the majority of depression symptoms at baseline and follow-up. Few concomitant symptoms, side effects, and other important clinical and treatment characteristics were recorded.


CONCLUSIONS
Inability to obtain charts due to plan or provider refusal, lack of available information in charts at key times in the course of illness, and missing data elements posed considerable challenges and prevented firm conclusions beyond those drawn from the parent, claims-based study.
Croghan
Thomas W
TW
Mathematica Policy Research, Inc., and Department of Medicine, Georgetown University School of Medicine, Washington, DC 20024, USA. tcroghan@mathematica-mpr.com
Esposito
Dominick
D
Daniel
Gregory
G
Wahl
Peter
P
Stoto
Michael A
MA
D057186:Comparative Effectiveness Research; D003863:Depression / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000188:drug therapy; D011996:Records; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors