Mesh : Humans Male Depressive Disorder, Treatment-Resistant / drug therapy Female Ketamine / administration & dosage Adult Middle Aged Retrospective Studies Nasal Sprays United States Antidepressive Agents / administration & dosage therapeutic use Health Services Accessibility / statistics & numerical data Administration, Intranasal Young Adult

来  源:   DOI:10.4088/JCP.23m15102

Abstract:
Background: Under a risk evaluation and mitigation strategy program, esketamine nasal spray CIII requires self administration at a certified treatment center. Our objective was to identify factors associated with esketamine initiation and continuation.
Methods: A retrospective observational cohort study was conducted among US adults who met treatment-resistant depression (TRD) criteria. Cases (n = 966) initiated esketamine between October 11, 2019, and February 28, 2022, and were compared to controls (n = 39,219) with TRD but no esketamine use. Outcomes included initiation, induction (8 administrations within 45 days), and interruptions (30-day treatment gap). Comorbid psychiatric conditions were identified using International Classification of Diseases, Tenth Revision, Clinical Modification, codes.
Results: Cases resided significantly closer to treatment centers (8.9 vs 20.3 miles). Compared to 0-9 miles, initiation rate decreased by 11.9%, 50.8%, 68.1%, 75.9%, and 92.8% for individuals residing 10-19, 20-29, 30-39, 40-49, and 50+ miles from a center. After adjustment, factors associated with increased likelihood of initiation were posttraumatic stress disorder, major depressive disorder with suicidal ideation, and male sex, while increasing distance, substance use disorder, Medicaid, Charlson Comorbidity Index (CCI), and older age were associated with lower likelihood. Factors associated with lower likelihood of completing induction were Medicaid, low socioeconomic status (SES), CCI, and Hispanic communities. Factors associated with increased likelihood of interruption were alcohol use disorder, distance, and minority communities, while generalized anxiety disorder and Medicaid were associated with lower likelihood.
Conclusions: Travel distance, insurance, low SES, and minority communities are potential barriers to treatment. Alternative care models may be needed to ensure adequate access to care.
J Clin Psychiatry 2024;85(2):23m15102.
摘要:
背景:在风险评估和缓解战略计划下,esketamine鼻喷雾剂CIII需要在认证的治疗中心自我给药。我们的目的是确定与艾氯胺酮开始和持续相关的因素。
方法:在符合难治性抑郁症(TRD)标准的美国成年人中进行了一项回顾性观察性队列研究。病例(n=966)在2019年10月11日至2022年2月28日之间开始使用艾氯胺酮,并与使用TRD但未使用艾氯胺酮的对照组(n=39,219)进行比较。结果包括启动,诱导(45天内8次给药),和中断(30天治疗间隔)。使用国际疾病分类确定合并症精神病,第十次修订,临床改造,代码。
结果:病例明显靠近治疗中心(8.9英里vs20.3英里)。与0-9英里相比,起爆率下降11.9%,50.8%,68.1%,75.9%,居住在距中心10-19、20-29、30-39、40-49和50英里以上的个人占92.8%。调整后,与启动可能性增加相关的因素是创伤后应激障碍,伴有自杀意念的重度抑郁症,和男性,在增加距离的同时,物质使用障碍,医疗补助,Charlson合并症指数(CCI),年龄和年龄与较低的可能性相关。与完成诱导的可能性较低相关的因素是医疗补助,低社会经济地位(SES),CCI和西班牙裔社区。与中断可能性增加相关的因素是酒精使用障碍,距离,和少数民族社区,而广泛性焦虑症和医疗补助与较低的可能性相关。
结论:行程距离,保险,低SES,和少数民族社区是治疗的潜在障碍。可能需要替代护理模式,以确保充分获得护理。
JClin精神病学2024;85(2):23m15102。
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