Anti-depressant Medication Management

Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported. 
a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). 
b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

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In 2017, over 17 million adults in the United States had at least one major depressive episode in the past 12 months (SAMHSA, 2018), and depression is estimated to affect nearly a quarter of adults in their lifetime (Burcusa & Iacono, 2007). Depression is associated with other chronic diseases, as it adversely affects the course, complications and management of other chronic medical illnesses such as diabetes, cancer, cardiovascular disease and asthma (Katon & Guico-Pabia, 2011).

Symptoms of depression include appetite and sleep disturbances, anxiety, irritability and decreased concentration (Charbonneau 
et al., 2005). The American Psychiatric Association recommends use of antidepressant medication and behavioral therapies, such as psychotherapy, to treat depression (American Psychiatric Association, 2010).

For the past 50 years, antidepressant medication has proven to be effective especially for patients with more severe symptoms (Fournier et al., 2010). Among patients who initiate antidepressant treatment, one in three discontinues treatment within one month, before the effect of medication can be assessed, and nearly one in two discontinues treatment within three months (Simon, 2002).

Clinical guidelines for depression emphasize the importance of effective clinical management in increasing patients’ medication compliance, monitoring treatment effectiveness, and identifying and managing side effects. If pharmacological treatment is initiated, appropriate dosing and continuation of therapy through the acute and continuation phases decrease recurrence of depression. Thus, evaluation of duration of pharmacological treatment serves as an important indicator in promoting patient compliance with the establishment and maintenance of an effective medication regimen.

American Psychiatric Association (2010): 
• “An antidepressant medication is recommended as an initial treatment choice for patients with mild to moderate major depressive disorder [I: Recommended with substantial clinical confidence] and definitely should be provided for those with severe major depressive disorder unless electroconvulsive therapy (ECT) is planned [I: Recommended with substantial clinical confidence].” 

• Patients should be given a realistic notion of what can be expected during the different phases of treatment, including the likely time course of symptom response and the importance of adherence for successful treatment and prophylaxis [I]. 

• During the acute phase of treatment, patients should be carefully and systematically monitored on a regular basis to assess their response to pharmacotherapy, identify the emergence of side effects (e.g., gastrointestinal symptoms, sedation, insomnia, activation, changes in weight, and cardiovascular, neurological, anticholinergic, or sexual side effects), and assess patient safety [I]. 

• “During the continuation phase of treatment, the patient should be carefully monitored for signs of possible relapse [I: Recommended with substantial clinical confidence]. Systematic assessment of symptoms, side effects, adherence, and functional status is essential [I: Recommended with substantial clinical confidence], and may be facilitated through the use of clinician- and/or patient-administered rating scales [II: Recommended with moderate clinical confidence]. To reduce the risk of relapse, patients who have been treated successfully with antidepressant medications in the acute phase should continue treatment with these agents for 4–9 months [I: Recommended with substantial clinical confidence].”

Department of Veterans Affairs, and Health Affairs, Department of Defense (2016):
• ”In patients at high risk for recurrent depressive episodes and who are treated with pharmacotherapy, we recommend offering maintenance pharmacotherapy for at least 12 months and possibly indefinitely.” [Strong For]
 
• “After initiation of therapy or a change in treatment, we recommend monitoring patients at least monthly until the patient achieves remission. At minimum, assessments should include a measure of symptoms, adherence to medication and psychotherapy, and emergence of adverse effects.” [Strong For]

• “In patients with MDD who achieve remission with antidepressant medication, we recommend continuation of antidepressants at the therapeutic dose for at least six months to decrease risk of relapse” [Strong For]

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder, 3rd edition. Arlington: Author.'

Reference Type: CITATION

Reference Text: 'Burcusa, S. L., & Iacono, W. G. (2007). Risk for recurrence in depression. Clinical Psychology Review, 27(8), 959-985.'

Reference Type: CITATION

Reference Text: 'Charbonneau, A., Bruning, W., Titus-Howard, T., et al. (2005). The community initiative on depression: Report from a multiphase work site depression intervention. Journal of Occupational and Environmental Medicine, 47(1), 60-67.'

Reference Type: CITATION

Reference Text: 'Fournier, J. C., DeRubeis, R. J., Hollon, S. D., et al. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA, 303(1), 47-53.'

Reference Type: CITATION

Reference Text: 'Katon, W., & Guico-Pabia, C. J. (2011). Improving quality of depression care using organized systems of care: A review of the literature. The Primary Care Companion to CNS Disorders, 13(1).'

Reference Type: CITATION

Reference Text: 'Simon, G. E. (2002). Evidence review: Efficacy and effectiveness of antidepressant treatment in primary care. General Hospital Psychiatry, 24(4), 213-224.'

Reference Type: CITATION

Reference Text: 'Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). Results from the 2017 National Survey on drug use and health: detailed tables. Retrieved from: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.htm#tab8-56A'

Reference Type: CITATION

Reference Text: 'Department of Veterans Affairs, Department of Defense. (2009). VA/DoD clinical practice guideline for management of major depressive disorder.?Retrieved from: https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf'

Index Prescription Start Date (IPSD): The date of the earliest prescription dispensing event for an antidepressant medication during the period of 245 days prior to the start of the measurement period through 120 days after the start of the measurement period.
The "continuous treatment" described in this measure allows for gaps in medication treatment up to a total 30 days during the 114-day period (numerator 1) or 51 days during the 231-day period (numerator 2). Gaps can include either gaps used to change medication, or treatment gaps to refill the same medication.

To identify new treatment episodes for major depression, there must be a 105-day negative medication history (a period during which the patient was not taking antidepressant medication) prior to the dispensing event associated with the Index Prescription Start Date.

This eCQM is a patient-based measure.
 
This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Patients 18 years of age and older who were dispensed antidepressant medications within 245 days (8 months) prior to the measurement period through the first 120 days (4 months) of the measurement period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event

Equals Initial Population

Patients who were actively on an antidepressant medication in the 105 days prior to the Index Prescription Start Date.

Exclude patients who are in hospice care for any part of the measurement period.

Numerator 1: Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date.

Numerator 2: Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment during the 231-day period following the Index Prescription Start Date.

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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