title: Association between chronic illness complexity and receipt of evidence-based depression care.
abstract: BACKGROUND
  The rate of guideline concordance with antidepressant treatment for persons with depression is low. The problem may be even more pronounced for patients with depression and other multiple chronic conditions (MCC).
  
  
  OBJECTIVE
  To study, for persons with new depressive episodes, the association between MCC and the likelihood of receiving guideline-concordant depression treatment.
  
  
  METHODS
  Retrospective cohort study using Veterans Affairs administrative data.
  
  
  METHODS
  A total of 43,189 Veterans Affairs patients who had a new depressive episode during 2007 were included.
  
  
  METHODS
  We assessed whether patients had an adequate supply of antidepressants during acute and continuation phases of depression treatment, which indicates guideline-concordant care. We determined the association between comorbid conditions and receipt of adequate antidepressant supplies after adjusting for potential confounders.
  
  
  RESULTS
  Compared with patients with depression alone, those with comorbid cardiovascular/cerebrovascular disease, peptic ulcer/gastroesophageal reflux disease (GERD), or arthritis were 8%-13% more likely to receive adequate antidepressant supplies during the acute phase. Patients with depression and substance/alcohol abuse were 15% less likely to receive adequate supplies in the acute treatment phase. Those with cardiovascular/cerebrovascular disease or peptic ulcer/GERD were 9%-10% more likely to receive continuation phase guideline-concordant depression treatment. Patients with comorbid substance/alcohol abuse were 19% less likely to receive continuation phase guideline-concordant depression treatment. Relatively few of the most prevalent MCC clusters were significantly associated with receipt of guideline-concordant depression treatment.
  
  
  CONCLUSIONS
  There was no consistent association between specific clusters of chronic conditions and adequate antidepressant supplies. There continues to be need for practice-level and system-level interventions to increase quality of depression treatment, particularly among persons with certain comorbid conditions such as cardiovascular/cerebrovascular disease, peptic ulcer/GERD, and arthritis.
authors.affiliation: *Department of Psychiatry & Behavioral Sciences †Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago ‡Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL §Department of Psychiatry, University of Michigan ∥Serious Mental Illness Treatment Research and Evaluation Center, Center for Clinical Management Research VA Ann Arbor Health System, Ann Arbor, MI ¶Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
authors.forename: Neil
authors.initials: N
authors.lastname: Jordan
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Brian
authors.initials: B
authors.lastname: Bartle
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Yuri
authors.initials: Y
authors.lastname: Lee
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D001168:Arthritis / Q000188:drug therapy / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology; D002908:Chronic Disease / Q000188:drug therapy* / Q000453:epidemiology*; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents