Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-30T19:42:44.841Z Has data issue: false hasContentIssue false

Adequacy of Pharmacotherapy Among Medicaid-Enrolled Patients Newly Diagnosed with Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  07 November 2014


Objective: To determine the adequacy of pharmacotherapy received by patients with newly-diagnosed obsessive-compulsive disorder (OCD), based on current practice guidelines.

Methods: A 9 year (1997–2006) retrospective claims analysis of adults enrolled in Florida Medicaid for at least 3 continuous years was conducted to determine the percentage who received both a minimally effective duration (≥ 8 continuous weeks) and dose of first-line OCD pharmacotherapy during the year following their first (“index”) OCD diagnosis.

Results: Among 2,960,421 adult (≥ 18 years of age) enrollees, 2,921 (0.1%) were diagnosed with OCD. Among the 2,825 OCD patients without comorbid Asperger syndrome or autism, 843 had newly-diagnosed OCD and at least 12 months of follow-up data after their index diagnosis. Among these 843 patients, 588 (69.7%) received first-line OCD pharmacotherapy but only 323 (38.3%) received a minimally effective pharmacotherapy trial in the year following their index diagnosis.

Conclusions: Among clinically-diagnosed persons with OCD (<10% of those with the disorder), a minority of newly-diagnosed patients receive a minimally effective pharmacotherapy trial consistent with current standards of care. Reasons such as limited patient adherence and/or physician awareness of guidelines must be identified and redressed to ameliorate the patient, healthcare system, and economic burdens associated with OCD.

Original Research
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1.Koran, LM, Hanna, GL, Hollander, E, Nestadt, G, Simpson, HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164(7 Suppl):553.Google Scholar
2.Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine. Clinical Practice Guidelines: Directions of a New Program. Washington, DC: National Academy Press; 1990.Google Scholar
3.Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593602.Google Scholar
4.Koran, LM. Quality of life in obsessive-compulsive disorder. Psychiatr Clin North Am. 2000;23:509517.Google Scholar
5.Mendlowicz, MV, Stein, MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157:669682.Google Scholar
6.Van Ameringen, M, Mancini, C, Farvolden, P. The impact of anxiety disorders on educational achievement. J Anxiety Disord. 2003;17:561571.Google Scholar
7.Katzelnick, DJ, Kobak, KA, DeLeire, T, et al. Impact of generalized social anxiety disorder in managed care. Am J Psychiatry. 2001;158:19992007.CrossRefGoogle ScholarPubMed
8.Roy-Byrne, P, Russo, J, Dugdale, DC, Lessler, D, Cowley, D, Katon, W. Undertreatment of panic disorder in primary care: role of patient and physician characteristics. J Am Board Fam Pract. 2002;15:443450.Google Scholar
9.Stein, MB, Sherbourne, CD, Craske, MG, et al. Quality of care for primary care patients with anxiety disorders. Am J Psychiatry. 2004;161:22302237.Google Scholar
10.Young, AS, Klap, R, Sherbourne, CD, Wells, KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58:5561.Google Scholar
11.Blanco, C, Olfson, M, Stein, DJ, Simpson, HB, Gameroff, MJ, Narrow, WH. Treatment of obsessive-compulsive disorder by US psychiatrists. J Clin Psychiatry. 2006;67:946951.Google Scholar
12.Denys, D, van Megen, H, Westenberg, H. The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder. Int J Psychopharmacol. 2002;17:109114.Google Scholar
13.Eisen, JL, Goodman, WK, Keller, MB, et al. Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. J Clin Psychiatry. 1999;60:346351; quiz 352.Google Scholar
14.Koran, LM, Leventhal, JL, Fireman, B, Jacobson, A. Pharmacotherapy of obsessive-compulsive disorder in a health maintenance organization. Am J Health Syst Pharm. 2000;57:19721978.CrossRefGoogle Scholar
15.Karno, M, Golding, JM, Sorenson, SB, Burnam, MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45:10941099.Google Scholar
16.Davidson, JR, Hughes, DL, George, LK, Blazer, DG. The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med. 1993;23:709718.Google Scholar
17.Mancebo, MC, Greenberg, B, Grant, JE, et al. Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Compr Psychiatry. 2008;49:4350.Google Scholar
18.DuPont, RL, Rice, DP, Shiraki, S, Rowland, CR. Economic costs of obsessive-compulsive disorder. Med Interface. 1995;8:102109.Google Scholar
19.Weisberg, RB, Dyck, I, Culpepper, L, Keller, MB. Psychiatric treatment in primary care patients with anxiety disorders: a comparison of care received from primary care providers and psychiatrists. Am J Psychiatry. 2007;164:276282.Google Scholar
20.Russell, AJ, Mataix-Cols, D, Anson, M, Murphy, DG. Obsessions and compulsions in Asperger syndrome and high-functioning autism. Br J Psychiatry. 2005;186:525528.Google Scholar
21.Fireman, B, Koran, LM, Leventhal, JL, Jacobson, A. The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization. Am J Psychiatry. 2001;158:19041910.Google Scholar
22.Hollander, E, Stein, DJ, Kwon, JH, et al. Psychosocial function and economic costs of obsessive-compulsive disorder. CNS Spectr. 1997;2:1625.Google Scholar
23.Pinto, A, Mancebo, MC, Eisen, JL, Pagano, ME, Rasmussen, SA. The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. J Clin Psychiatry. 2006;67:703711.Google Scholar
24.Marangell, LB, Silver, JM, Goff, DC, Yudofsky, SC. Psychopharmacology and Electroconvulsive Therapy. In: Hales, RE, Yudofsky, SC, eds. The American Psychiatric Publishing Textbook of Clinical Psychiatry, Fourth Edition. Washington, DC: American Psychiatric Publishing; 2003:10471150.Google Scholar
25.Olfson, M, Marcus, SC, Tedeschi, M, Wan, GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry. 2006;163:101108.CrossRefGoogle ScholarPubMed
26.Bull, SA, Hunkeler, EM, Lee, JY, et al. Discontinuing or switching selective serotonin-reuptake inhibitors. Ann Pharmacother. 2002;36:578584.Google Scholar
27.McGettigan, P, Kelly, A, Carvahlo, M, Feely, J. Anti-depressants in primary care: analysis of treatment discontinuations. Pharmacoepidemiol Drug Saf. 2000;9:521528.Google Scholar
28.Stein, DJ, Andersen, EW, Tonnoir, B, Fineberg, N. Escitalopram in obsessive-compulsive disorder: a randomized, placebo-controlled, paroxetine-referenced, fixed-dose, 24-week study. Curr Med Res Opin. 2007;23:701711.Google Scholar
29.Miller, BJ. A review of second-generation antipsychotic discontinuation in first-episode psychosis. J Psychiatr Pract. 2008;14:289300.Google Scholar
30.Sachs, GS, Nierenberg, AA, Calabrese, JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:17111722.CrossRefGoogle ScholarPubMed
31.LaSalle, VH, Cromer, KR, Nelson, KN, Kazuba, D, Justement, L, Murphy, DL. Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder. Depress Anxiety. 2004;19:163173.Google Scholar
32.Cabana, MD, Rand, CS, Powe, NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:14581465.Google Scholar
33.Hayward, RS. Clinical practice guidelines on trial. CMAJ. 1997;156:17251727.Google Scholar
34.Lomas, J, Anderson, GM, Domnick-Pierre, K, Vayda, E, Enkin, MW, Hannah, WJ. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med 1989;321:13061311.Google Scholar
35.Woolf, SH. Practice guidelines: a new reality in medicine. III. Impact on patient care. Arch Intern Med. 1993;153:26462655.Google Scholar
36.Trivedi, MH, Lin, EH, Katon, WJ. Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression. CNS Spectr. 2007;12(8 Suppl 13):127.Google Scholar
37.Bull, SA, Hu, XH, Hunkeler, EM, et al. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. JAMA. 2002;288:14031409.Google Scholar