Meunier, Matthew R.

AbstractRationale, aims and objectivesThe relationship between diabetes and depression is complex. The aim of this study was to study the impact of diabetic control in depressed primary care patients with diabetes on clinical remission of their depression at 6 months.MethodsThis study was a retrospective chart review analysis of 145 adult patients diagnosed with either major depressive disorder or dysthymia and had a score of 10 or greater on the PHQ‐9. The dependent variable for this study was depression remission at 6 months. The independent variables for this study were age, gender, marital status, race, BMI and HbA1c level within 2 months prior to the time of depression diagnosis.ResultsMultiple logistic regression modelling demonstrated that initial diabetic control or obesity were not independent predictors of depression remission at 6 months after index date. Also, the odds for the diabetes being in control (HbA1c <8.0%) after 6 months was only associated with being in control at baseline (OR 5.549, CI 2.364–13.024, P < 0.001).ConclusionsBaseline diabetic control does not appear to be an independent predictor for depression outcomes at 6 months. The best predictor of diabetic control after the diagnosis of depression was previous control of diabetes.

Depression symptoms contribute to significant morbidity and health care utilization. The aim of this study was to determine the impact of symptom improvement (to remission) on outpatient clinical visits by depressed primary care patients. This study was a retrospective chart review analysis of 1733 primary care patients enrolled into collaborative care management (CCM) or usual care (UC) with 6-month follow-up data. Baseline data (including demographic information, clinical diagnosis, and depression severity) and 6-month follow-up data (Patient Health Questionnaire scores and the number of outpatient visits utilized) were included in the data set. To control for individual patient complexity and pattern of usage, the number of outpatient visits for 6 months prior to enrollment also was measured as was the presence of medical comorbidities. Multiple logistic regression analysis demonstrated that clinical remission at 6 months was an independent predictor of outpatient visit outlier status (>8 visits) (odds ratio [OR] 0.609, confidence interval (CI) 0.460–0.805, P <0.01) when controlling for all other independent variables including enrollment into CCM or UC. The OR of those patients not in remission at 6 months having outpatient visit outlier status was the inverse of this at 1.643 (CI 1.243–2.173). The most predictive variable for determining increased outpatient visit counts after diagnosis of depression was increased outpatient visits prior to diagnosis (OR 4.892, CI 3.655–6.548, P <0.01). In primary care patients treated for depression, successful treatment to remission at 6 months decreased the likelihood of the patient having more than 8 visits during the 6 months after diagnosis. ( Population Health Management 2014;17:180–184)

Background: The inclusion of mental health issues in the evaluation of multimorbidity generally has been as the presence or absence of the condition rather than severity, complexity, or stage. The hypothesis for this study was that clinical outcome of the depression 6 months after enrollment into collaborative care management would have a role in predicting future complexity of care tier. Methods: This study was a retrospective chart review of 1894 primary care patients who were diagnosed with major depressive disorder or dysthymia as of December 2012. Multiple logistic regression analysis was used to test the independent associations between each variable and the odds of being included in the higher tiers (HT) group. Results: Age (odds ratio [OR] = 1.022, confidence interval [CI] = 1.013-1.030, P < .001), female gender (OR = 1.380, CI = 1.020-1.868, P = .037), being married (OR = 0.730, CI = 0.563-0.947, P = .018), and the presence of comorbidities (1, OR = 1.986, CI = 1.485-2.656, P < .001; ≥2, OR = 4.678, CI = 3.242-6.750, P < .001) were independently associated with future HT levels. The presence of persistent depressive symptoms (PHQ-9 ≥10) at 6 months conferred 2.280 (CI = 1.673-3.107, P < .001) times likely odds of HT level compared with clinical remission at 6 months. Conclusion: Patients with the diagnosis of major depression or dysthymia had greater odds of complex tier levels in the future, if depression was not treated to remission by 6 months. This study demonstrated the importance of the goal of significant improvement (ie, remission) of depression symptoms by 6 months (especially those older patients with more comorbidity) from entering into the higher complexity tiers.

Collaborative care management (CCM) for depression has been demonstrated to improve clinical outcomes. The impetus for this study was to determine if outpatient utilization patterns would be associated with depression outcomes. The hypothesis was that depression remission would be independently correlated with outpatient utilization at 6 and 12 months after enrollment into CCM. The study was a retrospective chart review analysis of 773 patients enrolled into CCM with 6- and 12-month follow-up data. The data set comprised baseline demographic data, patient intake self-assessment scores (Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder-7, Mood Disorder Questionnaire, and Alcohol Use Disorders Identification Test), the number of outpatient visits, and follow-up PHQ-9 scores. To control for individual patient complexity and pattern of usage, the number of outpatient visits for 6 months prior to enrollment also was measured. With a logistic regression model for outpatient visit outlier status as the dependent variable, remission at 6 months (odds ratio [OR] 0.519, CI [confidence interval] 0.349–0.770, P =0.001) and remission at 12 months (OR 0.573, CI 0.354–0.927, P =0.023) were predictive. With this inverse relationship between remission and outlier status, those patients who were not in remission had an OR of 1.928 for outpatient visit outlier status at 6 months after enrollment and an OR of 1.745 at 12 months. Patients who improved clinically to remission while in CCM had decreased odds of outlier status for outpatient utilization at 6 and 12 months when controlling for all other study variables. Improvement in health care outcomes by CCM could translate into decreased outpatient utilization for depressed patients. ( Population Health Management 2014;17:48–53)

Background: Polypharmacy has been identified as a quality indicator, but no studies have been reported about the epidemiology of polypharmacy among hospital patients at discharge. Methods: Records of 142 family medicine patients aged ≥65 years who were discharged from the hospital during the period November 2008 to October 2009 were extracted. Forty-six of these patients were readmitted within 30 days and the remaining 96 not readmitted within 30 days. Polypharmacy was measured as >16 medications at dismissal. Independent variables related to person (use of medical care in the 12 months prior to hospitalization, number of high-risk diagnoses, and demographic characteristics), place (living situation at admission and disposition location), and time (month of admission). Chronic obstructive pulmonary disease, cancer, diabetes mellitus, congestive heart failure, and coronary artery disease were diagnoses determined to be high-risk. Results: Mean number of medications at dismissal was 13.5 and 23.2% of patients were prescribed more than 16 medications. No interactions were found between readmission status and any of the independent variables. Use of medical services in the previous year was not related to polypharmacy and no seasonal pattern was detected. Two or more high-risk diagnoses were independently related to polypharmacy (odds ratio [OR] = 4.75, confidence interval [CI] = 1.0-11.2, P = .00). Being discharged to a location with personal health services such as home care or a skilled nursing facility was also related to polypharmacy (OR = 3.07, CI = 1.3-7.2, P = .01). Conclusion: Drug reviews intended to reduce the rate of polypharmacy among discharged persons aged ≥65 years can be targeted at patients who have 2 or more high-risk diagnoses and at those discharged to receive personal health services either at home or in a convalescence facility.