International Journal of Health Care Quality Assurance

Purpose – The purpose of this paper is to compare predictors of receipt of recommended first-line pharmacotherapy in three generational cohorts of patients with new episode depression.

Design/methodology/approach – This retrospective database cohort study included adolescent, adult and senior Quebec Public Prescription Drug Insurance Plan beneficiaries with new episode depression, who were diagnosed by primary care physicians or psychiatrists (October 2000 to March 2001) and received pharmacotherapy. Receipt of recommended first-line pharmacotherapy, based on the first psychoactive medication dispensed following the depression diagnosis, was defined according to Canadian guidelines.

Findings – Receipt of first-line pharmacotherapy was documented in 52 percent, 71 percent and 50 percent of adolescents, adults and seniors, respectively. Among adolescents and seniors, diagnosis by a psychiatrist was associated with a lower likelihood of receipt of recommended pharmacotherapy. Adolescent females and senior males were more likely and adults with comorbidity were less likely to receive recommended pharmacotherapy. For all age groups, having a physician who both diagnosed the depression and prescribed the initial pharmacotherapy was associated with an increased likelihood of receiving recommended pharmacotherapy. Relational continuity of care influenced receipt of recommended first-line pharmacotherapy. Gender differences in treatment were found in adolescents and seniors.

Originality/value – This paper identifies predictors of receipt of recommended first-line pharmacotherapy in three generational cohorts of patients with new episode depression.