4.45 PATHWAY TO DEPRESSION CARE IN CHILDREN AND ADOLESCENTS FIRST IDENTIFIED BY PRIMARY CARE PROVIDERS VERSUS PSYCHIATRISTS

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 55; no. 10; p. S177
• Main Authors: Yucel, Aylin, BS, MBA, MS, Essien, Ekere, MD, DrPH, Aparasu, Rajender R., PhD, Mgbere, Osaro, PhD, Bhatara, Vinod, MD, Alonzo, Joy, MBBS, Chen, Hua, MD
• Format: Journal Article
• Language: English
• Published: Baltimore Elsevier BV 01.10.2016
• Subjects: Adherence; Adolescents; Antidepressants; Bipolar disorder; Child & adolescent psychiatry; Children; Coordination; Depression; Diagnosis; Drugs; Health disparities; Help seeking behavior; Hospitalization; Medicaid; Medical diagnosis; Medical personnel; Mental depression; Mental disorders; Mental health; Mental health care; Modification; Patients; Pediatrics; Primary care; Psychiatrists; Psychiatry; Quality of care; Visits
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2016.09.240

Objectives: The health professional contacted first for MDD diagnosis and treatment may determine the route of care-seeking pathway (CSP), as well as the receipt of care. This study evaluated CSP for pediatric patients identified by PCP or psychiatrists (PSY) for MDD with respect to follow-up visits, antidepressant medication (ADM) adherence, and mental health (MH)-related hospitalization. Methods: Data used for this study were obtained from 2006-2007 Medicaid Analytic eXtract (MAX) for New York State and comprised 850 children and adolescents aged 10-20 years, with a minimum of two consecutive MDD diagnoses (ICD-9-Clinical Modification: 296.2, 296.3, 300.4, 311) and administration of ADM. Patients with bipolar disorders were excluded. Patients identified by PCP [N = 587 (69 percent)] or PSY [N = 263 (31 percent)] were followed for 6 months to observe differences in the management pattern. ADM adherence was measured as having ADM 84 of the first 114 days of index prescription (HEDIS). The plurality approach was used to define the principal provider (PP) as either PCP or PSY, based on the number of visits (≥ 50 percent). Results: Pediatric MDD cases first identified by PSY were younger (10-13 years; PSY: 27 percent vs. PCP: 20 percent; P = 0.02), mostly male (PSY: 44 percent vs. PSY: 22 percent, P < 0.001), white (PSY: 48 percent vs. PCP: 37 percent, P = 0.02), and with preindex psychiatric comorbidities (PSY: 79 percent vs. PCP: 64 percent, P < 0.001). A small percentage of patients exclusively continued with the same specialty for MDD care (PCP-identified: 6 percent vs. PSY-identified: 12 percent, P < 0.01). Less than half (43 percent) of PCP-identified cases had PSY as their PPs, whereas only 16 percent of PSY-identified PSY-identified cases had PCP as their PPs (P < 0.0001). Compared with PCP-identified patients, PSY-identified patients received more follow-up visits [mean (SD): PSY: 9.57 (9.06) vs. PCP: 7.36 (7.67), P = 0.007]; had better ADM adherence (PSY: 54 percent vs. PCP: 45 percent, P = 0.01); and less hospitalization (PCP: 15 percent vs. PSY: 2 percent, P = 0.002). Conclusions: The findings of this study provide evidence that disparities in quality and outcome exist between PCP- and PSY-initiated MDD diagnosis and treatment. Care coordination may be a solution to bridge the gap and eventually eliminate the disparities in the quality of MDD care and patients' outcome.