208010 Do symptoms of depression alter older adults' perceptions of health care access?

Monday, November 9, 2009

Joshua M. Thorpe, PhD, MPH , School of Pharmacy, University of Wisconsin - Madison, Madison, WI
Carolyn T. Thorpe, PhD, MPH , Department of Population Health Sciences, University of Wisconsin – Madison, Madison, WI
Korey A. Kennelty, PharmD , School of Pharmacy, University of Wisconsin - Madison, Madison, WI
Betty Chewning, PhD , University of Wisconsin-Madison, Madison, WI
While depression is well-known risk factor for non-adherence to recommended medical care, mechanisms for this relationship are unknown. The purpose of this study was to assess one possible pathway linking depression to poor adherence; specifically, the link between depressive symptoms and perceived barriers in access to care.

Data were drawn from the 2004 wave of the Wisconsin Longitudinal Study (WLS), a longitudinal study of 5,465 men and women who graduated from Wisconsin high schools in 1957 (ages 63-67 years, 54% female). Depressive symptoms were categorized using scores on the Center for Epidemiologic Studies Depression Scale (CES-D) (≥16=high, <16=low). Fifteen items from the Group Health Association of America Consumer Satisfaction Survey (CSS) access subscale were selected to assess respondent's satisfaction with the (1) convenience of provider's location, (2) hours of operation, (3) office wait time, (4) availability of information by phone, (5) arrangements for making appointments by phone, (6) length of time waiting between making an appointment and the day of the appointment, (7) adequacy of time with the provider, (8) with out-of-pocket costs (9) services available for getting prescriptions filled, (10) access to mental health, (11) specialty, (12) routine care, (13) emergency care, (14) hospitals, and (15) overall quality of care. Responses to CSS items of poor/fair were categorized as a perceived access barrier. Selection of control variables was guided by the Andersen behavioral model (i.e., predisposing, enabling, medical need). Bivariate logistic regression models were estimated to determine total effects of depressive symptoms on each barrier, and then were adjusted for predisposing, enabling, and need factors.

The percentage of respondents perceiving an access barrier ranged from 3% for perceived access to hospitals to 31% for dissatisfaction with out-of-pocket costs. Unadjusted results revealed that those with high depressive symptoms were more likely to perceive all 15 barriers; odds ratios ranged from 1.49 (p<.001) for out-of-pocket costs to 2.53 for access to “routine” care (p<.001). With the exception of perceived barriers to prescription services and specialists, these disparities persisted in adjusted models.

These results suggest that older adults with high depressive symptoms -- a group with great potential need for healthcare services -- may perceive greater barriers in accessing a wide range health services. Perceived barriers in access may, therefore, be an important mediator linking depression to poor adherence. These findings could inform interventions to facilitate health-promoting adherence behaviors in person with poor mental health.

Learning Objectives:
Identify the important pathways that link mental health and health-promoting behaviors such as medication adherence and receiving preventive care.

Keywords: Access to Health Care, Depression

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: BA, 1995 Neuroscience, Hamilton College MPH, 2000 Epidemiology, George Washington University PhD, 2005 Policy & Outcomes, University of North Carolina-Chapel Hill School of Pharmacy. Currently Principal Investigator on two grants. One is an R03 from the National Institute on Aging to study inappropriate medication use in both dementia patients and caregivers. The other is a two-year pilot grant from the Wisconsin Comprehensive Memory Program to examine barriers to medical care and medication adherence in persons with dementia. Relevant Methodological Training: Expertise conducting secondary data analyses using a wide range of existing Federal and administrative databases, and works to develop ways to exploit existing data to measure quality of care and identify inequities in access to services. Relevant Publications: Thorpe JM, Sleath, BL, Thorpe CT, Van Houtven CH, Blalock SJ, Landerman LR, Campbell WH, Clipp EC. Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia. Medical Care. 2006 Aug;44(8). Thorpe JM, Kalinowski CT, Patterson ME, Sleath BL. Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States. Medical Care. 2006 Feb;44(2):187-191
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.