Follow-up visits by provider specialty for patients with major depressive disorder initiating antidepressant treatment

Objectives: This study examined the association between provider specialty and guideline-concordant care after the initiation of antidepressant treatment. Methods: Medical and prescription claims were analyzed from adults newly diagnosed as having major depressive disorder who initiated antidepressant treatment. Follow-up visits during the first 90 days after the index prescription were identified, and an indicator for receipt of guideline-concordant care (three or more visits) was created. Logistic regression models were used, and propensity score matching techniques were applied. Sensitivity analyses were conducted to investigate how results differed by varying the approach to identify followup visits. Results: The study included 4,102 patients, and only 31% received guideline-concordant follow-up visits. Patients receiving their initial prescription from psychiatrists were nearly five times as likely as patients receiving their initial prescription from primary care providers to receive guideline-concordant follow-up care (odds ratio=4.6, 95% confidence interval=3.9-5.4). Conclusions: Routine care for antidepressant management falls short of guideline recommendations, especially in primary care.