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

  • Cheryl S. Hankin, Lorrin M. Koran, Amy Bronstone, Donald W. Black, David V. Sheehan, Eric Hollander, Jeffrey D. Dunn, Larry Culpepper, John Knispel, Darin D. Dougherty and Zhaohui Wang...


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.


Corresponding author

Please direct all correspondence to: Cheryl S. Hankin, PhD, President and Chief Scientific Officer, BioMedEcon, LLC, P.O. Box 129, Moss Beach, CA 94038; Tel: 650-563-9475, Fax: , 650-563-9485; e-mail: ,


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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.
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.
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.
4.Koran, LM. Quality of life in obsessive-compulsive disorder. Psychiatr Clin North Am. 2000;23:509517.
5.Mendlowicz, MV, Stein, MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157:669682.
6.Van Ameringen, M, Mancini, C, Farvolden, P. The impact of anxiety disorders on educational achievement. J Anxiety Disord. 2003;17:561571.
7.Katzelnick, DJ, Kobak, KA, DeLeire, T, et al. Impact of generalized social anxiety disorder in managed care. Am J Psychiatry. 2001;158:19992007.
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.
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.
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.
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.
12.Denys, D, van Megen, H, Westenberg, H. The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder. Int J Psychopharmacol. 2002;17:109114.
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.
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.
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.
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.
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.
18.DuPont, RL, Rice, DP, Shiraki, S, Rowland, CR. Economic costs of obsessive-compulsive disorder. Med Interface. 1995;8:102109.
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.
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.
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.
22.Hollander, E, Stein, DJ, Kwon, JH, et al. Psychosocial function and economic costs of obsessive-compulsive disorder. CNS Spectr. 1997;2:1625.
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.
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.
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.
26.Bull, SA, Hunkeler, EM, Lee, JY, et al. Discontinuing or switching selective serotonin-reuptake inhibitors. Ann Pharmacother. 2002;36:578584.
27.McGettigan, P, Kelly, A, Carvahlo, M, Feely, J. Anti-depressants in primary care: analysis of treatment discontinuations. Pharmacoepidemiol Drug Saf. 2000;9:521528.
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.
29.Miller, BJ. A review of second-generation antipsychotic discontinuation in first-episode psychosis. J Psychiatr Pract. 2008;14:289300.
30.Sachs, GS, Nierenberg, AA, Calabrese, JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:17111722.
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.
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.
33.Hayward, RS. Clinical practice guidelines on trial. CMAJ. 1997;156:17251727.
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.
35.Woolf, SH. Practice guidelines: a new reality in medicine. III. Impact on patient care. Arch Intern Med. 1993;153:26462655.
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.
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.


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