Depression Care in a Chronically Ill Medicare Population

Abstract

Objective: The purpose of this study is to examine the quality of depression care among chronically ill Medicare Advantage beneficiaries. Methods: This study includes 5,898 patients with a depression diagnosis enrolled between 2008 and 2010 in Humana Cares, a care management program that supports chronically ill Medicare Advantage members. The sample was stratified by age groups (those < 65 years old and those >= 65 years old). An old-old group (>= 75 years old) was also compared to those aged 65-74. Two outcome indicators were created to measure depression care within the initial 180 days after a depression diagnosis: 1) Any depression care (>= 1 antidepressant prescription or at least 1 specialty mental health visit) and 2) Among those receiving any depression care, those receiving an antidepressant prescription for at least 90 days or at least 2 specialty visits. Multivariable analysis using logistic regression was used to examine the correlates of depression care. Results: Among those less than 65 years old, 72% received any depression care with 75% receiving at least 90 days of an antidepressant and/or 2 or more specialty visits. Among those 65 years old and older, 65% received any depression care with 67% receiving at least 90 days of an antidepressant and/or 2 or more specialty visits. For both age groups, female gender, medical comorbidities, and dual eligibility were positively associated with an antidepressant prescription. In the older group, female gender was positively associated with at least a 90 day supply of an antidepressant prescription, while substance use disorders were negatively associated with receiving a minimum of 90 days of an antidepressant. In the older age group, the old-old (75 years or older), female gender, and dual insurance status were significantly less likely to have at least one specialty visit. Regional differences and certain psychiatric comorbidities were also associated with receiving depression care. Conclusion: Two-thirds of the depressed patients in this Medicare Advantage population received any depression care. The old-old and older females are less likely to receive depression care. Although the presence of psychiatric disorders is associated with depression care, the presence of substance use disorders is not associated with depression care.