QUALITY OF ANTIDEPRESSANT MEDICATIONS PRESCRIBED AT DISCHARGE TO DEPRESSED ELDERLY PATIENTS IN GENERAL MEDICAL HOSPITALS BEFORE AND AFTER PROSPECTIVE PAYMENT SYSTEM

This study describes the quality of antidepressant medication use at h ospital discharge for depressed elderly inpatients and compares qualit y of care before and after implementation of Medicare's Prospective Pa yment System (PPS). The study reviewed data from medical records of 27 46 depressed, elderly, hospitalized patients in acute-care general med ical hospitals in five U. S. states (pre-PPS period 1981-82; post-PPS period 1985-86). The majority were discharged on antidepressant medica tion both pre-PPS and post-PPS. After PPS' implementation, sedating me dications were used less often in all treatment settings. In general m edical wards, a higher percentage post-PPS (24%) than pre-PPS (14%) we re discharged 48 hours or less after first starting an antidepressant medication. In both time periods, one-third of patients receiving anti depressant medications were prescribed daily dosages at discharge belo w recommended, minimum, therapeutic levels, whether treated in general medical wards or psychiatric units. Otherwise, patients previously tr eated in psychiatric units received higher quality of medication manag ement than those treated in general medical wards. Over time, patients discharged on antidepressant medication were less likely to use sedat ing medication, suggesting improved quality of care. In general medica l wards, however, patients were discharged more rapidly after starting medication, possibly suggesting lower quality of care. A substantial percentage of patients received subtherapeutic dosages of medication o r sedating medications, suggesting that improved management of dischar ge antidepressant medication in the elderly is needed in general medic al hospitals,