While spending for Medicaid patients with depression has increased substantially, there have been only small improvements in care, a new study shows.
Researchers analyzed data from Medicaid patients treated for depression in Florida between July 1996 and June 2006. The patients, aged 18 to 64, had one or more hospitalisations for depression or had at least two outpatient claims of depression on different days.
There were between 8,970 and 13,265 patients each year, with a total of 56,805 during the entire study period.
Over 10 years, spending increased from an average of $2,802 (about R22 400) per patient to $3,610 (about R 28 000) per patient, a 29% increase. This increase was due to a 110% rise in drug spending, most of which was the result of a 949% increase in spending on antipsychotic drugs, according to a journal news release.
The percentage of patients who used antidepressants rose from 81% to 87%, the use of anxiety medications remained stable (from 63% to 64%), and the use of antipsychotic drugs increased from 26% to 42% of patients.
The percentage of patients who received psychotherapy fell from 57% to 38% and the percentage of patients who were hospitalised decreased from 9% to 5%. The researchers also found a decrease in the number of follow-up visits.
"In summary, during the 10-year period between 1996 and 2005, we found a substantial increase in spending for patients with depression, with minimal improvements in quality of care," concluded Dr Catherine Fullerton, of Harvard Medical School and Cambridge Health Alliance, and colleagues in the release.
"Our findings underscore the importance of continued efforts to improve quality of care for individuals with depression, as well as the need to understand the efficacy and cost-effectiveness of using antipsychotics for the treatment of individuals with depression in the general community."
The study appears in the journal Archives of General Psychiatry.
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