Response, partial response, and nonresponse in primary care treatment of depression.

BACKGROUND: Depressive disorders are one of the most common reasons for visits to primary care physicians. This study identifies factors related to poor response to depression treatment with selective serotonin reuptake inhibitors (SSRIs) in primary care settings by (1) examining clinical response taking into account treatment, (2) comparing baseline characteristics and outcomes between patients classified by response, and (3) examining characteristics predicting poor response. METHODS: A Randomized Trial Investigating SSRI Treatment (ARTIST) was a prospective naturalistic trial comparing effectiveness of SSRI therapy. Eligible patients were randomized to treatment (N = 601) and followed up for 9 months. Treatment patterns were classified as "adequate" (6-month continuous medication), "aggressive" (defined by a treatment algorithm), or "inadequate" (discontinuations) by patient-reported medication use. Clinical response was determined by use of the Symptom Checklist-20 (SCL-20), with patients classified as remitters (score < or =6), partial remitters (50% decrease in symptoms), or nonresponders. Groups were compared on baseline characteristics, functioning, and treatment patterns. Multinomial logistic regression was used to determine predictors of response. RESULTS: Of patients completing 6-month evaluations (n = 482), 46% were classified as nonresponders. Additionally, 53% (n = 256) received adequate therapy but did not achieve remission and 13% (n = 61) had aggressive therapy associated with treatment resistance. Significant predictors of nonresponse included older age, diagnosis, worse physical functioning, and lower energy level. CONCLUSIONS: A substantial number of adequately treated patients did not respond to antidepressant therapy. Some of these patients may be considered undertreated or treatment-resistant according to current treatment guidelines recommending dose increases or medication switches for less than adequate clinical response.

Use of pharmacoeconomic data in making hospital formulary decisions.

The use of pharmacoeconomic data in hospital formulary decisions was explored. Data were collected from pharmacist members of pharmacy and therapeutics (P&T) committees in 204 Florida hospitals. Participants were asked, via a cross-sectional telephone survey, to rate 10 factors used in making formulary decisions from 1 (most important) to 10 (least important). Participants were also asked about the usual sources of pharmacoeconomic data used by the P&T committee, the types of pharmacoeconomic analyses and humanistic outcome measures that have been used by the P&T committee to make formulary decisions, and the availability of someone with pharmacoeconomic skills to assist with the formulary decision-making. The average time spent collecting data was 19 minutes. Data were analyzed using descriptive statistics and correlation analysis. Eighty-six percent of the participants indicated that pharmacoeconomic data were used all the time or very often when formulary decisions were made, with only 6% stating that these data were rarely or never used. Pharmacoeconomic data were rated by 63% of participants to be very important in formulary decisions. The usual sources of pharmacoeconomic data listed by participants are inhouse data (75%), published literature (57%), and pharmaceutical industry studies (13%). Participants rated drug efficacy, toxicity, and side effects as the most important and avoiding use of home infusions as the least important factors in making hospital formulary decisions. About 70% of the hospitals had someone with pharmacoeconomic skills on staff, while 4% reported consulting with an external pharmacoeconomics expert. Most P&T committees in Florida hospitals relied on pharmacoeconomic data to assist them in making formulary decisions.

A focus group study of factors influencing African-American men's prostate cancer screening behavior.

This study was conducted to identify the factors perceived by African-American men as influencing their behavior relative to prostate cancer screening. A total of 49 African-American men, age 40 and above, participated in 10 focus group discussions in Florida. Data collection was between October 12, 2001 and March 9, 2002 in Tallahassee, Tampa, and Miami. Data analysis was conducted using a comprehensive ethnographical analysis, including the use of an ethnographical retrieval program, Nonnumerical Unstructured Data Indexing Searching and Theorizing (QSR NUD*IST 4.0) software. Factors identified as influencing prostate cancer screening participation by African-American men were impediments to prostate cancer screening; positive outcome beliefs associated with prostate cancer screening; social influence; negative outcome beliefs associated with prostate cancer screening; resources or opportunities that facilitate prostate cancer screening; prostate cancer knowledge; perceived susceptibility to prostate cancer; perceived threat of prostate cancer; perceived severity of prostate cancer; positive health activities; illness experience; and prostate cancer screening intervention message concept, message source, and message channel. The results of this study may offer an excellent guide to designing effective, culturally sensitive, and relevant interventions, which would increase African-American men's participation in prostate cancer screening.