Racial Differences in Antidepressant Use Among Older Home Health Care Patients
ABSTRACT The objective of this study was to determine the association of race (black and white) with depression diagnosis and antidepressant use among older home health care patients.
Cross-sectional data were obtained from the 2007 National Home and Hospice Care Survey of patients 65 years and older (N=3,157). Data were analyzed by race, antidepressant use, and charted depression diagnosis.
Whites had greater odds than blacks of receiving a depression diagnosis (adjusted odds ratio [AOR]=4.46, 95% confidence interval [CI]=1.52-13.09). Whites with no depression diagnosis were also more likely to receive an antidepressant (AOR=2.62, CI=1.58-4.36); however, the difference in receipt of an antidepressant between whites and blacks with a depression diagnosis was not significant.
Older blacks were less likely than older whites to receive antidepressants, independent of a depression diagnosis. This finding suggests that older blacks with depression in home health care may face two disparities relative to whites: underdiagnosis and undertreatment of depression.
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ABSTRACT: The objective of this study is to determine the racial/ethnic effect of depression symptom recognition by home healthcare nurses. This is a secondary analysis of administrative data from a large urban home healthcare agency. Patients' age were 65 years and older with a valid depression screen, identified as Caucasian, African American, or Hispanic and admitted to homecare in 2010 (N = 3711). All demographic and clinical information were obtained from the electronic medical record. Subjects were 29.34% Caucasian, 37.81% African American, and 32.85% Hispanic. About 6.52% had a formal chart diagnosis of depression, and 13.39% received antidepressant therapy. The rates of positive depression screens by nurses were higher in Caucasians than that of in African Americans or Hispanics (13.41% vs. 9.27% vs. 10.99%; χ(2) = 10.70, df [degrees of freedom] = 2; p < 0.01). Depression screening rates were then stratified by the number of clinical indicators from the chart (depression diagnosis or antidepressant on medication list). The proportion of positive screen increased for minorities with an increase in the number of indicators. African Americans had significantly greater positive screens with two indicators compared with that of the Caucasians and Hispanics (50.00% vs. 23.81% vs. 35.59%; χ(2) = 6.65, df = 2; p = 0.04). These findings show a wide range of variation in screening for depression among ethnic groups. The rates increase for minorities with the presence of increased clinical indicators, suggesting that nurses may screen higher in minorities when there is higher clinical suspicion. Future research in home healthcare should be aimed at training nurses to conduct culturally tailored depression screening to improve management of depression in older minorities. Copyright © 2013 John Wiley & Sons, Ltd.International Journal of Geriatric Psychiatry 11/2014; 29(11). DOI:10.1002/gps.4001 · 3.09 Impact Factor
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ABSTRACT: OBJECTIVE: Determine the racial/ethnic effect on depression treatment among home healthcare patients. DESIGN: Cross-sectional analyses of administrative data. SETTING: A large home healthcare agency in Bronx, NY. PARTICIPANTS: Patients 65 years and older admitted to homecare in 2010 (N = 3,744). MEASUREMENTS: Patient Health Questionnaire (PHQ)-2 depression screen. Other data, such as diagnosis, medications, and demographics, were collected from the patient electronic medical record. RESULTS: 6.52% of the sample had a depression diagnosis, 11.11% screened positive for depression (+PHQ-2), and 13.39% were prescribed antidepressants. The odds of receiving an antidepressant among those who screened positive for depression were 0.42 (95% confidence interval [CI]: 0.22-0.79) for African Americans and 0.49 (95% CI: 0.26-0.93) for Hispanics compared with Caucasians. CONCLUSIONS: These findings suggest that disparities continue to exist in depression treatment for older minority home healthcare patients compared with older Caucasians.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 05/2013; DOI:10.1016/j.jagp.2013.01.078 · 3.52 Impact Factor
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ABSTRACT: Background/Objective There is a paucity of research on how depression is identified and treated among Medicare home healthcare (HHC) patients age 65+ with disability. The Centers for Medicare and Medicaid Services (CMS) recently incorporated depression screening into the OASIS-C HHC assessment. Our study objectives were to evaluate and characterize depression care management (DCM) in a HHC agency after CMS increased its depression requirements, and to determine if there was an association of DCM with disability (activities of daily living [ADL]) outcomes. Design A retrospective chart review (N=100). All patients (mean age=81.7) were new Medicare HHC admissions age 65+ who screened positive for depression and had disability and multimorbidity. Methods Clinical and administrative records were examined and descriptive analyses were used. Multivariate regression analyses investigated the association of 6 DCM components with ADL improvement. Results Depression was recognized by nurses in the care plans of 60% of the patients. Documentation of only one nurse care management activity, antidepressant use, indicated the use of evidence-based standards of depression assessment and DCM. Depression measures were not administered at discharge, recertification, or transfer. Forty percent of patients had a formal depression diagnosis by the referring physician in the chart, and 65% were receiving an antidepressant. Having a depression care plan and depression medication were significantly associated with a large ADL improvement. Conclusions Despite the association of depression care plans with patient disability improvement, there was inadequate adherence to evidence-based DCM. Medicare and HHC agencies must ensure adherence to DCM, including follow-up depression assessment for patients with positive screens.American Journal of Geriatric Psychiatry 06/2014; DOI:10.1016/j.jagp.2014.06.009 · 3.52 Impact Factor