OUTPATIENT ANTIDEPRESSANT UTILIZATION IN A DUTCH SICK FUND

Objective: To identify quality improvement opportunities in the manage ment of depression by evaluating patterns of antidepressant use and co ncurrent use of anxiolytics or sedative/hypnotics among patients who i nitiated therapy with amitriptyline, fluoxetine, fluvoxamine, or parox etine. Design: A longitudinal, retrospective study using electronic pr escription data from a Dutch sick fund, ZAO Zorgverzekeringen. Patient s and Methods: The study patients (n = 2,554) initiated therapy betwee n October 1, 1994 and December 31, 1995. Follow-up periods were 6 mont hs (antidepressant use) and 60 days (concurrent anxiolytic and sedativ e/hypnotic use). Results: The three key findings were as follows: (1) the majority of patients received less than 4 months of therapy (more common for patients receiving amitriptyline); (2) the average daily do ses for initial prescriptions for all four study drugs were below the recommended therapeutic minimums for depression (overall and final ami triptyline doses also were consistently low); and (3) the incidence of concurrent anxiolytic and sedative/hypnotic use during days 2-60 afte r antidepressant therapy initiation was 18.2%. Conclusion: The study s uggests that patients in this Dutch sick fund were not likely to recei ve either adequate antidepressant doses or adequate durations of thera py relative to Dutch guidelines for the treatment of depression. These findings are consistent with findings in other Dutch, European, and U S studies and may present opportunities for quality improvement.