Browsing by Author "Harman, Jeffrey S."

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    Comparative effectiveness of dual-action versus single-action antidepressants for the treatment of depression in people living with HIV/AIDS
    (Elsevier, 2017-06) Mills, Jon C.; Harman, Jeffrey S.; Cook, Robert L.; Marlow, Nicole M.; Harle, Christopher A.; Duncan, R. Paul; Bengston, Angela M.; Pence, Brian W.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    Background Depression is the most common psychiatric comorbidity among people living with HIV/AIDS (PLWHA). Little is known about the comparative effectiveness between different types of antidepressants used to treat depression in this population. We compared the effectiveness of dual-action and single-action antidepressants in PLWHA for achieving remission from depression. Methods We used data from the Centers for AIDS Research Network of Integrated Clinic Systems to identify 1175 new user dual-action or single-action antidepressant treatment episodes occurring from 2005 to 2014 for PLWHA diagnosed with depression. The primary outcome was remission from depression defined as a Patient Health Questionnaire-9 (PHQ-9) score <5. Mean difference in PHQ-9 depressive symptom severity was a secondary outcome. The main approach was an intent-to-treat (ITT) evaluation complemented with a per protocol (PP) sensitivity analysis. Generalized linear models were fitted to estimate treatment effects. Results In ITT analysis, 32% of the episodes ended in remission for both dual-action and single-action antidepressants. The odds ratio (OR) of remission was 1.02 (95%CI=0.63,1.67). In PP analysis, 40% of dual-action episodes ended in remission compared to 32% in single-action episodes. Dual-action episodes had 1.33 times the odds of remission (95%CI=0.55,3.21), however the result was not statistically significant. Non-significant differences were also observed for depressive symptom severity. Limitations Missing data was common but was addressed with inverse probability weights. Conclusions Results suggest that single-action and dual-action antidepressants are equally effective in PLWHA. Remission was uncommon highlighting the need to identify health service delivery strategies that aid HIV providers in achieving full remission of their patients’ depression.
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    Electronic Health Record Availability and Anxiety Treatment in Office Based Practices
    (2016-10) Harman, Jeffrey S.; Mills, Jon; Cook, Robert L.; Harle, Christopher A.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: This study compared the probability of receiving anxiety treatment during a physician visit to primary care practices with and without an electronic health record (EHR). Methods: The 2007–2010 National Ambulatory Medical Care Survey was used to identify visits for anxiety (N=290). The outcome was receipt of anxiety treatment. The independent variable was the presence of a fully functioning EHR. Logistic regression was used to conduct the analysis. Results: Patients who were seen in practices with a fully functioning EHR had lower odds of being offered antianxiety medication (adjusted odds ratio [AOR]=.37, 95% confidence interval [CI]=.15–.90, p=.028), mental health counseling (AOR=.43, CI=.18–1.04, p=.061), and any anxiety treatment (AOR=.40, CI=.15–1.05, p=.062) compared with patients at practices without a fully functioning EHR. Conclusions: EHRs may have a negative impact on the delivery of care for anxiety during primary care visits. Future studies should monitor the impact of EHRs on delivery and quality of care.