Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort
Objectives To describe the population that meets the criteria for major depressive disorder (MDD) in British Columbia (BC), compare patterns of healthcare utilisation between those with MDD who are and are not prescribed pharmacotherapy, and assess these relationships in models that control for pote...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e078287.full |
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| author | Sonya Cressman Louisa Edwards Kimberlyn McGrail Stirling Bryan Alison Hoens Rohit Vijh Sandra Peterson Zeina Waheed Mary Bunka Nick Pang Shahzad Ghanbarian Gavin Wong Linda Riches Jehannine Austin |
| author_facet | Sonya Cressman Louisa Edwards Kimberlyn McGrail Stirling Bryan Alison Hoens Rohit Vijh Sandra Peterson Zeina Waheed Mary Bunka Nick Pang Shahzad Ghanbarian Gavin Wong Linda Riches Jehannine Austin |
| author_sort | Sonya Cressman |
| collection | DOAJ |
| description | Objectives To describe the population that meets the criteria for major depressive disorder (MDD) in British Columbia (BC), compare patterns of healthcare utilisation between those with MDD who are and are not prescribed pharmacotherapy, and assess these relationships in models that control for potential confounding variables.Design We used a population cross-sectional study design among a cohort of individuals living with MDD and examined the relationship between pharmacotherapy and healthcare utilisation between 2019 and 2020 using linked billing and administrative data.Setting This study identified individuals with MDD using a validated case definition of International Classification of Diseases (ICD) codes in BC, Canada.Participants The final study cohort included 549 029 adult participants who met the MDD case definition.Explanatory variable Explanatory variable was the use of prescription antidepressant medication during the study period, based on BC PharmaNet data.Covariates Covariates include sociodemographic characteristics (age, sex, urban/rural residence, neighbourhood income quintile and comorbidities).Primary outcome measure Primary outcome measure was healthcare utilisation (outpatient physician visits, emergency department (ED) visits and hospitalisations).Results We stratified our analysis based on whether study participants were classified as ‘recently incident’ or ‘actively prevalent’. The odds ratio (OR) for health service utilisation between the pharmacotherapy group and the non-pharmacotherapy group for individuals who were recently incident was 8.14 (95% CI 7.40, 8.95) for outpatient physician visits, 1.04 (95% CI 1.02, 1.07) for ED visits and 1.05 (95% CI 1.00, 1.10) for hospitalisations, after adjusting for comorbidities and other sociodemographic variables in our regression analyses, whereas for the actively prevalent group the ORs were 7.57 (7.27, 8.49), 0.91 (0.89, 0.92) and 1.00 (0.98, 1.02), respectively.Conclusion This study examined the association of pharmacotherapy on healthcare utilisation for adults with MDD in BC. The study revealed higher outpatient physician visits for the pharmacotherapy group and no major association for inpatient visits. For ED visits, recently incident individuals on pharmacotherapy had slightly higher odds of having an ED visit, whereas individuals who were actively prevalent and on pharmacotherapy had a slight decrease in odds. This may suggest a protective effect of pharmacotherapy against a utilisation of resource-intensive healthcare services. |
| format | Article |
| id | doaj-art-9bf58882ae8945c3883dfbc7c995efef |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-9bf58882ae8945c3883dfbc7c995efef2025-08-20T02:36:00ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2023-078287Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohortSonya Cressman0Louisa Edwards1Kimberlyn McGrail2Stirling Bryan3Alison Hoens4Rohit Vijh5Sandra Peterson6Zeina Waheed7Mary Bunka8Nick Pang9Shahzad Ghanbarian10Gavin Wong11Linda Riches12Jehannine Austin135 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada3 Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada8 Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada3 Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada4 Undergraduate Medical Education, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada1 School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada6 Patient Partner, Vancouver, British Columbia, Canada7 Medical Genetics, The University of British Columbia, Vancouver, British Columbia, CanadaObjectives To describe the population that meets the criteria for major depressive disorder (MDD) in British Columbia (BC), compare patterns of healthcare utilisation between those with MDD who are and are not prescribed pharmacotherapy, and assess these relationships in models that control for potential confounding variables.Design We used a population cross-sectional study design among a cohort of individuals living with MDD and examined the relationship between pharmacotherapy and healthcare utilisation between 2019 and 2020 using linked billing and administrative data.Setting This study identified individuals with MDD using a validated case definition of International Classification of Diseases (ICD) codes in BC, Canada.Participants The final study cohort included 549 029 adult participants who met the MDD case definition.Explanatory variable Explanatory variable was the use of prescription antidepressant medication during the study period, based on BC PharmaNet data.Covariates Covariates include sociodemographic characteristics (age, sex, urban/rural residence, neighbourhood income quintile and comorbidities).Primary outcome measure Primary outcome measure was healthcare utilisation (outpatient physician visits, emergency department (ED) visits and hospitalisations).Results We stratified our analysis based on whether study participants were classified as ‘recently incident’ or ‘actively prevalent’. The odds ratio (OR) for health service utilisation between the pharmacotherapy group and the non-pharmacotherapy group for individuals who were recently incident was 8.14 (95% CI 7.40, 8.95) for outpatient physician visits, 1.04 (95% CI 1.02, 1.07) for ED visits and 1.05 (95% CI 1.00, 1.10) for hospitalisations, after adjusting for comorbidities and other sociodemographic variables in our regression analyses, whereas for the actively prevalent group the ORs were 7.57 (7.27, 8.49), 0.91 (0.89, 0.92) and 1.00 (0.98, 1.02), respectively.Conclusion This study examined the association of pharmacotherapy on healthcare utilisation for adults with MDD in BC. The study revealed higher outpatient physician visits for the pharmacotherapy group and no major association for inpatient visits. For ED visits, recently incident individuals on pharmacotherapy had slightly higher odds of having an ED visit, whereas individuals who were actively prevalent and on pharmacotherapy had a slight decrease in odds. This may suggest a protective effect of pharmacotherapy against a utilisation of resource-intensive healthcare services.https://bmjopen.bmj.com/content/14/12/e078287.full |
| spellingShingle | Sonya Cressman Louisa Edwards Kimberlyn McGrail Stirling Bryan Alison Hoens Rohit Vijh Sandra Peterson Zeina Waheed Mary Bunka Nick Pang Shahzad Ghanbarian Gavin Wong Linda Riches Jehannine Austin Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort BMJ Open |
| title | Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort |
| title_full | Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort |
| title_fullStr | Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort |
| title_full_unstemmed | Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort |
| title_short | Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort |
| title_sort | relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in british columbia canada a retrospective population based cohort |
| url | https://bmjopen.bmj.com/content/14/12/e078287.full |
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