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Topic Overview:
Major depression ranks among the most common chronic health conditions in the elderly, affecting about 6 million Americans over the age of 65. Depression frequently coexists with and exacerbates other chronic medical conditions such as hypertension, heart disease, and diabetes. Fewer than half of depressed older adults receive appropriate antidepressant medication to manage their condition, leading ultimately to increased health care costs and service utilization and poorer quality of life. A major barrier to pharmacologic treatment of depression in older adults is high out-of-pocket costs for antidepressants.

Dr. Donohue’s research focuses on the effect of recent changes in health care policy on medication access and spending among older adults with depression and other chronic medical conditions. In January 2006, a new Medicare drug benefit plan (Part D) expanded access to beneficiaries who previously had limited or no prescription drug coverage. Early studies indicate that Part D is reducing out-of-pocket drug expenditures and increasing medication utilization. However, until now, no breakdown by clinical condition has been performed.

Dr. Donohue’s study is the first to examine the impact of expanded drug benefits through Medicare Part D on the treatment of depression in older adults. Using a pre/post with comparison group study design, she analyzed medical and pharmacy insurance claims data from more than 30,000 Medicare beneficiaries with a diagnosis of depression throughout Western Pennsylvania over a four-year period. Her outcome measures included the initiation of antidepressant therapy, duration of therapy, and adequate adherence before and after implementation of Part D. She also examined the impact of the new drug benefit on other non-drug medical care expenditures, including reductions in inpatient hospital, emergency department, and outpatient physician services for depression and other comorbid medical conditions.

Dr. Donohue’s research has widespread implications for addressing the barriers to achieving optimal quality of care for depressed elders. Her additional work focuses on removing cost-related barriers to utilization of evidence-based treatment for other chronic conditions like congestive heart failure through value-based insurance design and other changes to health insurance.