Archive

Archive for the ‘Journal of the American Board of Family Medicine’ Category

Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures

November 4, 2014 Comments off

Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures
Source: Journal of the American Board of Family Medicine

Background:
Use of brief depression symptom measures for identifying or screening cases may help to address depression undertreatment, but whether it also leads to diagnosis and treatment of patients with few or no symptoms—a group unlikely to have major depression or benefit from antidepressants—is unknown. We examined the associations of use of a brief depression symptom measure with depression diagnosis and antidepressant recommendation and prescription among patients with few or no depression symptoms.

Methods:
We conducted exploratory observational analyses of data from a randomized trial of depression engagement interventions conducted in primary care offices in California. Analyses focused on participants scoring <10 on a study-administered 9-item Patient Health Questionnaire (PHQ-9) (completed immediately before an office visit and not disclosed to the provider) with complete chart review data (n = 595). We reviewed visit notes for evidence of practice administration of a brief symptom measure (independent of the trial) and whether the provider (1) diagnosed depression or (2) recommended and/or prescribed an antidepressant.

Results:
Among the 545 patients without a practice-administered measure, 57 (10.5%) had a visit diagnosis of depression; 9 (1.6%) were recommended and another 21 (3.8%) prescribed an antidepressant. Among the 50 patients (8.4% of total sample) with a practice-administered measure, 10 (20%) had a visit diagnosis of depression; 6 (12%) were recommended and another 6 (12%) prescribed an antidepressant. Adjusting for nesting within providers, trial intervention, stratification variables, and sample weighting, use of a brief symptom measure was associated with depression diagnosis (adjusted odds ratio, 3.2; 95% confidence interval, 1.1–9.2) and antidepressant recommendation and/or prescription (adjusted odds ratio, 3.80; 95% confidence interval, 1.0–13.9). Analyses using progressively lower PHQ-9 thresholds (<9 to <5) and examining antidepressant prescription alone yielded consistent findings. Analyses by practice-administered measure (PHQ-9 vs PHQ-2) indicated the study findings were largely associated with PHQ-9 use.

Conclusions:
These exploratory findings suggest administration of brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant recommendation and prescription among patients unlikely to have major depression. If these findings are confirmed, researchers should investigate the balance of benefits and risks (eg, overdiagnosis of depression and overtreatment with antidepressants) associated with use of a brief symptom measure.

About these ads

Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors

November 29, 2013 Comments off

Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors
Source: Journal of the American Board of Family Medicine

Background:
Economists posit 2 mechanisms increasing financial risk to insurers after health insurance gain: ex ante moral hazard (riskier behavior because of reduced personal costs) and ex post moral hazard (increased use of care because of lower care costs). In contrast, the Health Belief Model (HBM), would anticipate no increase in risk behaviors while also predicting increased health care utilization following insurance gain (because of reduced financial barriers to accessing care). Empirical studies examining the association of insurance change with changes in preventive care and health behaviors have been limited and yielded mixed findings. The objective of this study was to examine the association of health insurance change (gain or loss of coverage) with changes in preventive care and health behaviors in a large, nationally representative sample.

Methods:
We analyzed data from adults ≥18 years old and enrolled for 2 years in the 2000 to 2009 Medical Expenditure Panel Surveys (n = 76,518). Conditional logistic regression analyses modeled year-to-year individual changes in preventive care and health behaviors associated with individual changes in insurance status, adjusting for characteristics varying year to year (income, employment, total health care expenditures, office visits, prescriptions, availability of usual source of care, and health status). Preventive care included adherence to influenza vaccination, colorectal cancer screening, mammography, and Papanicolaou and prostate-specific antigen testing. Health behaviors examined were becoming nonobese, quitting smoking, and adopting consistent use of seatbelts.

Results:
Insurance gain (loss) was associated with increases (decreases) in preventive care (adjusted odds ratios [95% confidence intervals]: influenza vaccine, 1.27 [1.04–1.56]; colorectal cancer screening, 1.48 [0.96–2.29]; Papanicolaou testing, 1.56 [1.22–2.00]; mammography, 1.70 [1.21–2.38]; prostate-specific antigen, 1.42 [0.98–2.05]). Insurance change was not associated with significant changes in health behaviors.

Conclusions:
Consistent with both economic theory and the HBM, preventive care increased (decreased) after gaining (losing) coverage. In contrast, health behaviors changed little after insurance change, consistent with the HBM but not with the potential for decreased personal health care costs (ex ante moral hazard).

Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006

July 8, 2012 Comments off

Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006
Source: Journal of the American Board of Family Medicine

Background:
Published studies about the association of obesity with mortality have used body mass index (BMI) data collected more than 10 years ago, potentially limiting their current applicability, particularly given evidence of a secular decline in obesity-related mortality. The objective of this study was to examine the association between BMI and mortality in a representative, contemporary United States sample.

Methods:
This was a population-based observational study of data from 50,994 adults aged 18 to 90 years who responded to the 2000 to 2005 Medical Expenditures Panel Surveys. Cox regression analyses were employed to model survival during up to 6 years of follow-up (ascertained via National Death Index linkage) by self-reported BMI category (underweight, <20 kg/m2; normal weight, 20-<25 [reference]; overweight, 25-<30; obese, 30-<35; severely obese, ≥35), without and with adjustment for diabetes and hypertension. Survival by BMI category also was modeled for diabetic and hypertensive individuals. All models were adjusted for sociodemographics, smoking, and Medical Expenditures Panel Surveys response year.

Results:
In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories.

Conclusions:
Obesity-associated mortality risk was lower than estimated in studies employing older BMI data. Only severe obesity (but not milder obesity or overweight) was associated with increased mortality, an association accounted for by coexisting diabetes and hypertension. Mortality in diabetes was lower among obese versus normal weight individuals.

See: Above-Normal Weight Alone Does Not Necessarily Increase Short-Term Risk of Death, U.S. Data Suggest (Science Daily)

Follow

Get every new post delivered to your Inbox.

Join 957 other followers