title: Antidepressant Medication Management Among Older Patients Receiving Home Health Care.
abstract: OBJECTIVE
  Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay.
  
  
  METHODS
  Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients aged 65 years or older who received HHC in 2006-2007 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (versus discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy.
  
  
  RESULTS
  About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10- to 20-percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change.
  
  
  CONCLUSIONS
  Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY. Electronic address: yub2003@med.cornell.edu.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Department of Quality, Baptist Memorial Health Care Corporation, Memphis, TN.
authors.forename: Huibo
authors.initials: H
authors.lastname: Shao
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Press
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D054539:Medication Therapy Management; D009819:Office Visits; D017063:Outcome Assessment, Health Care; D019555:Physician-Nurse Relations; D012189:Retrospective Studies; D014481:United States
chemical_list: D000928:Antidepressive Agents
keywords: Medication management; antidepressants; home health care