Chronic medical illness, depression, and use of acute medical services among medicare beneficiaries

Background: This study assessed the relation of comorbid depressive syndrome with utilization of emergency department services and preventable inpatient hospitalizations among elderly individuals with chronic medical conditions. Research Design: A cross-sectional study. Setting: Individuals greater than or equal to 65 years of age living in the United States with Medicare part A and B fee-for-service coverage in 1999. Subjects: A 5% random sample of elderly Medicare recipients (N = 1,238,895) of whom 60,382 (4.9%) met criteria for a depressive syndrome. Measurements: Medicare beneficiaries were stratified based on the presence of at least 1 of the following medical conditions: coronary artery disease, diabetes mellitus, congestive heart failure, hypertension, prostate cancer, breast cancer, lung cancer, or colon cancer. For each stratum, we compared the odds of emergency department visits, all-cause hospitalization, and hospitalization for ambulatory care sensitive conditions (ACSC), conditions for which timely and effective medical care could decrease risk of hospitalization, for beneficiaries with and without a depressive syndrome. Results: Compared with those without a depressive syndrome, beneficiaries with a depressive syndrome were more likely to be older, white, and female (P < 0.001). For each of the 8 chronic medical conditions, elderly beneficiaries with a depressive syndrome were at least twice as likely to use emergency department services (range of adjusted odds ratios, 2.12-3.16; P < 0.001); medical inpatient hospital services (range of adjusted odds ratios, 2.59-3.71; P < 0.001); and medical inpatient hospital services associated with an ACSC (range of adjusted odds ratios, 1.72-2.68; P < 0.001) as compared with those without a depressive syndrome. Conclusions: For elderly individuals with at least 1 chronic medical condition, the presence of a depressive syndrome increased the odds of acute medical service use, suggesting that improvements in clinical management, access to mental health services, and coordination of medical and mental health services could reduce utilization.