Associations between untreated depression and secondary health care utilization in patients with hypertension and/or diabetes
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We determined the prevalence of untreated depression in patients with hypertension (HT) and/or diabetes (DM) and estimated the extra health care use and expenditures associated with this comorbidity in a rural Hungarian adult population. We also assessed the potential workload of systematic screening for depression in this patient group.
General health check database from a primary care programme containing survey data of 2027 patients with HT and/or DM was linked to the outpatient secondary care use database of National Institute of Health Insurance Fund Management. Depression was ascertained by Beck Depression Inventory score and antidepressant drug use. The association between untreated depression and secondary healthcare utilization indicated by number of visits and expenses was evaluated by multiple logistic regression analysis controlled for socioeconomic/lifestyle factors and comorbidity. The age-, sex- and education-specific observations were used to estimate the screening workload for an average general medical practice.
The frequency of untreated depression was 27.08%. The untreated severe depression (7.45%) was associated with increased number of visits (OR 1.60, 95% CI 1.11–2.31) and related expenses (OR 2.20, 95% CI 1.50–3.22) in a socioeconomic status-independent manner. To identify untreated depression cases among patients with HT and/or DM, an average GP has to screen 42 subjects a month.
It seems to be reasonable and feasible to screen for depression in patients with HT and/or DM in the primary care, in order to detect cases without treatment (which may be associated with increase of secondary care visits and expenditures) and to initiate the adequate treatment of them.
KeywordsComorbid depression Hypertension Diabetes Health care utilization Linkage study
The authors thank all the participants who took the time to complete the questionnaires and the members of general practitioners’ cluster who participated in data collection. Furthermore, the authors thank Alexandra Balázs for support in managing the legal issues related to data access. The reported study was carried out in the framework of the “Public Health Focused Model Programme for Organising Primary Care Services Backed by a Virtual Care Service Centre” (SH/8/1). The Model Programme is funded by the Swiss Government via the Swiss Contribution Programme (SH/8/1) in agreement with the Government of Hungary. Additional source of funding was from GINOP-2.3.2-15-2016-00005 project which was co-financed by the European Union and the European Regional Development Fund.
Concept/design: AP, JS, MP; data collection: AP, JS, MP, LK, ZSF, LP; data analysis/interpretation: AP, JS, ZSB, PD, ZR; drafting manuscript: AP, JS, PD, ZR. All authors contributed to the writing of the final version of the paper.
Compliance with ethical standards
The study protocol was approved by the Ethics Committee of the Hungarian National Scientific Council on Health (TUKEB 16676-3/2016/EKU, 0361/16). All enrolled patients signed an informed consent form contributing to the storage and analysis of their data before the data collection of health check started. Furthermore, the legal staff of the National Institute of Health Insurance Fund Management checked each signed informed consent before issuing the permission for record linkage. The health insurance numbers of the patients were handled exclusively on computers of and within the National Institute of Health Insurance Fund Management by this institution’s own staff members dedicated to handling these sensitive data as their usual job. Nobody else from the study personnel obtained permission to handle these data.
Conflict of interest
ZR has in the past received speakers’ bureau honoraria, advisory board funding or travel support from AstraZeneca, Janssen, Lundbeck, Lilly, Servier-EGIS, Richter and TEVA-Biogal. The other authors report no biomedical financial interests or potential conflicts of interest. The authors declare that the presented epidemiological research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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