June 23, 2005

Medicaid Patients' Depression Not Effectively Treated

According to a recent survey, Medicaid patients' depression is not being effectively treated. Medicaid patients were less likely than patients' with private insurance to be treated by practice guidelines. The guidelines are made so that patients' with depression and other mental disorders get the necessary alleviation from their symptoms.

More than 85 percent of both privately insured and Medicaid patients with depression are not being effectively treated, as defined by the National Committee for Quality Assurance (NCQA), according to new data presented at the annual meeting of the American Psychiatric Association.

While both sets of patients were receiving inadequate treatment in this study, Medicaid claimants were less likely to be treated according to practice guidelines. This population was nearly twice as likely to be prescribed an antidepressant below the recommended dose (19 percent vs. 10 percent, respectively); less likely to stay on medication for more than 60 days (39 percent vs. 55 percent, respectively), the duration of time recommended for effective acute treatment; and half as likely to have their antidepressant switched or augmented (5 percent vs. 10 percent, respectively) when they did not respond or tolerate their current dose or medication.

According to practice guidelines, if a patient does not feel better after two months of treatment, their physician should increase the dose, switch medications or augment with a second medication or psychotherapy to help patients achieve success. Complete resolution of all depression symptoms is the goal of treatment. When symptoms don't go away completely, patients can have difficulty getting well and staying that way.

"Although patients in this study overcome the first, and very difficult, hurdle of receiving help, the treatment they received often wasn't adequate," said Rebecca Robinson, MS, health outcomes researcher, Eli Lilly and Company. "Healthcare providers need to follow through the continuum of care to ensure adequate quality care is provided to these patients by following treatment guidelines and giving patients access to medications that will increase their chances of getting well and staying well."

Additional Study Highlights

Medicaid patients scored lower than those with private insurance on all three components of the Antidepressant Medication Management (AMM) measures. Medicaid patients were more than five times less likely to attend the three recommended follow-up visits with their physician or mental health professional (5 percent vs. 29 percent, respectively) in the 12-weeks following diagnosis and prescription of antidepressant medication. They were also considerably less likely to receive effective acute treatment after a new episode of depression (39 percent vs. 61 percent, respectively) or recommended continuation care in the six months following the episode (22 percent vs. 44 percent, respectively). The one state that was similar to private insurance had greater access to antidepressant medications.

On average, Medicaid claimants were younger, sicker, and more likely to have capitated insurance plans, which includes an annual set dollar limit on payment for health care services.

Impact of Depression on Society

Major depressive disorder is the leading cause of disability in the United States and results in more days of disability than chronic medical conditions like heart disease, hypertension, diabetes and lower back pain. Depression costs the United States more than $83 billion annually: more than $26 billion in direct medical costs and approximately $57 billion in indirect costs. An estimated 16 percent of the costs of antidepressants are associated with patients who were never adequately treated. Inadequate dose and duration of antidepressant treatment has been reported to directly hinder treatment outcomes.

More than 200 million days of work are lost each year due to depressive disorders and, on average, 55 percent of costs are absorbed by employers because of absenteeism and lost work productivity. The annual cost of lost productive work time, excluding short- and long-term disability costs, time among US workers with depression was $44 billion. Individuals with major depression consistently reported the most lost productive work time when it co-occurred with pain, weakness, or fatigue; gastrointestinal complaints, and sensory or nerve impairment. Most of the costs were for reduced performance while at work rather than absenteeism -- less than one third of these workers reported use of antidepressants in the previous 12 months and treatment effectiveness was reported to be moderate.

This study used participants beginning treatment for depression with antidepressants and followed their progress over a 12-month period. The study did not use subjects who had already started antidepressant use prior to the beginning of this study. Those with a diagnosis of schizophrenia, bipolar disorder, or psychoses were not used, but this does not mean that this study does not have any significance for them. If Medicaid patients' with depression are being given this kind of treatment, it is likely that those with other mental disorders are being treated similarly. Of course, this study can not substantiate this claim since it did not use any people who had schizophrenia, bipolar disorder, or psychoses.

For the full press release on this story go to: http://tinyurl.com/aclzn

For Eli Lilly and Company's website go to: http://www.lilly.com/index.html

The source of this press release was Eli Lilly and Company

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