OBJECTIVES: To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults (age≥65 years) with dementia and major depressive disorder (MDD).

METHODS: A retrospective cohort study was conducted using Medicare 5% sample data (2011-2013), where first antidepressant prescription claim from May 1, 2011 through April 30, 2012 was considered Index prescription start date (IPSD). Based on HEDIS guidelines, adherence during acute and continuation phase AMM was defined as: (i) at least 84 days of antidepressant use during 114 days post-IPSD and (ii) at least 180 days of antidepressant use during 231 days post-IPSD, respectively. Study outcomes included all-cause mortality, all-cause hospitalization, and falls/factures (with mortality being the competing event for hospitalization and falls/fractures) during follow-up from end of acute/continuation phase AMM adherence. Due to proportionality assumption violation of Cox models, fully non-parametric approaches (Kaplan-Meier analysis and Modified Gray’s test) were used for time-to-event analysis adjusting for inverse probability of treatment weights.

RESULTS: Final study samples consisted of 4,330 [adherent(N)=3,114 (71.92%)] and 3,941 [adherent(N)=2,407 (61.08%)] older adults with dementia and MDD during acute and continuation phase treatments, respectively. No significant difference (p>0.05) between adherent and non-adherent groups were observed in terms of all-cause mortality and falls/fractures in both acute and continuation phases. There was a significant difference in time to all cause hospitalization (p=0.018), with median times 530 (95%CI: 499-587) and 425 (95%CI: 364-492) days for adherent and non-adherent groups, respectively. However, no significant (p=0.126) all-cause hospitalization risk was observed with continuation phase AMM adherence.

CONCLUSIONS: Acute phase adherence to HEDIS AMM was associated with reductions in all-cause hospitalization risk among older adults with dementia and MDD; however, no other difference was observed with other study outcomes between adherent and non-adherent groups.