Three-year follow-up of healthcare utilization and expenditure of patient with first diagnosis depressive disorder

[[abstract]]Objective: This study was to investigate three-year follow-up of healthcare utilization and reimbursement of patient with the first diagnosis depressive disorder and analyz its related factor. Furthermore, providing government the evidence-based data of promoting patients with depressive disorder care in decision-making. Methods: This was a retrospective study analyzing secondary data. The source of data came from claim data of all set of sampled registry of beneficiaries of National Health Insurance from 1996 to 2003. Patient had the first diagnosis of depressive disorder (ie, ICD-9-CM code 296.2, 296.3, 300.4, 311) in 2000. Patients with previous depressive disorders and/or treatment with an antidepressant were excluded from the analysis. A total of 875 patients with first diagnosis depressive disorders were collected, continuously followed three-year medical utilization and reimbursement. Results: The incidence of depressive disorder was 0.44% in 2000. There were 60.7% female patients, 58.3% in 30-59 years old and 26.6% in 60 years old and above, 41.8% of patients with the first diagnosis depressive disorder to look for care initially in the psychiatry department . Only 20.5% patients went to psychiatry department over 4 times in the next year, and 3.5% transfer rate from non-psychiatry department to psychiatry department in the first year. In outpatient service, emergency medical treatment and inpatient rate, the medical utilization of patients with the first diagnosis depressive disorder was over the national average utilization rate. Patients with the first diagnosis depressive disorder had significant higher medical use in non-depression-related outpatient, inpatient and emergency service. The utilization of the depression-related outpatient service in the second and third year was obviously lower (29.6% and 24.0%). There were significant higher depression-related outpatient utilization in major depression, older and the first year psychiatry department rate over 4 times. There were significant higher non-depression-related outpatient utilization in older, female, before first diagnosis year high medical expense and first year no copayment patient. There were significant higher non-depression-related inpatient utilization in older and catastrophic illness. Follow three years period, only 55% of patients with the first diagnosis depressive disorder used antidepressant in the first year. The second and third year antidepressant utilization was 23.7% and 21% respectively. The total drug day of first diagnosis depressive disorder patients were 88.6 days, 129.1 days and 139.1 days respectively. The antidepressant service points were 3249.9 points, 4342.3 points and 4613.7points. The utilization of antidepressant was significantly related to major depression, older, patients with the first diagnosis depressive disorder went to psychiatry department above 4 times. Conclusion and recommendation: According to this results, majority of the depressive disorder patients still sought non-psychiatry department services. The transfer rate from non-psychiatry department to psychiatry department were obviously low. The medical utilization and usage of antidepressant of depressive disorder patients in the second and third were obviously lower than the first year. Based on the results of this study, a few suggestions were proposed as the following: The Bureau of National Health Insurance should increase the incentive to the non-psychiatry general physicians to transfer major depression patients to the psychiatry department and encourage hospitals to realize the case management and continuity of care