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Healthy Skepticism Library item: 13308

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Sleath B, Shih YC.
Sociological influences on antidepressant prescribing.
Soc Sci Med 2003 Mar; 56:(6):1335-44
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-45XR7RB-6&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=893985323b5cdcc788511ca4d3bde959


Abstract:

This study examined how patient characteristics, physician characteristics, the physician’s interaction with the health care system, and the physician’s interaction with the patient influenced whether patients with a depression diagnosis received an antidepressant prescription and whether they received a SSRI antidepressant, a non-SSRI antidepressant, or both.The 1998 National Ambulatory Medical Care Survey (NAMCS), in the USA, was used for the analysis. Logistic regression was used to examine what characteristics influenced whether a patient with a depression diagnosis received an antidepressant prescription. Next, a multinomial logistic regression model was applied to examine the relative risk of using one type of antidepressant versus another among antidepressant users while correcting for possible sample selections using the Heckman selection model. Sixty-seven percent of patients with a depression diagnosis received an antidepressant. Patients who were seeing providers who were not primary care physicians or psychiatrists, self-paying patients, and patients with neurotic depression were significantly less likely to receive an antidepressant prescription. Patients with depression listed as their first diagnosis were significantly more likely to receive an antidepressant prescription. Patients seeing a psychiatrist were more likely than patients seeing a primary care physician to receive a non-SSRI antidepressant than a SSRI antidepressant. Patients belonging to an HMO that had capitated visits were over four times more likely to receive non-SSRI antidepressants than SSRI antidepressants. Patients with major depression were significantly more likely to receive a non-SSRI antidepressant. Patients with depression as their primary diagnosis and patients who saw psychiatrists were significantly more likely to receive both SSRI and non-SSRI antidepressants rather than just SSRI antidepressants. Patient characteristics, physician characteristics, the physician’s interaction with the health care system, and the physician’s interaction with the patient all influenced antidepressant prescribing. An especially important finding was that insurance status influenced whether patients received an antidepressant. Health care providers need to take the time to help patients without insurance obtain antidepressant medication if it is needed.

Keywords:
Publication Types: Research Support, U.S. Gov't, P.H.S. MeSH Terms: Adolescent Adult Aged Ambulatory Care/economics Ambulatory Care/organization & administration* Ambulatory Care/statistics & numerical data Antidepressive Agents/classification Antidepressive Agents/economics Antidepressive Agents/therapeutic use* Antidepressive Agents, Second-Generation/economics Antidepressive Agents, Second-Generation/therapeutic use Depressive Disorder/drug therapy* Depressive Disorder/economics Depressive Disorder/ethnology Drug Utilization/economics Drug Utilization/statistics & numerical data* Female Health Care Surveys Health Maintenance Organizations/economics Health Maintenance Organizations/statistics & numerical data Humans Insurance Coverage Logistic Models Male Middle Aged Physician's Practice Patterns/economics Physician's Practice Patterns/statistics & numerical data* Physician-Patient Relations Primary Health Care/economics Primary Health Care/statistics & numerical data Psychiatry/economics Psychiatry/statistics & numerical data Serotonin Uptake Inhibitors/economics Serotonin Uptake Inhibitors/therapeutic use Socioeconomic Factors United States Substances: Antidepressive Agents Antidepressive Agents, Second-Generation Serotonin Uptake Inhibitors

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909