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Background: Neighborhood stress score (NSS) and area deprivation index (ADI) are two neighborhood-based composite measures used to quantify an individual's socioeconomic risk based on home location. In this analysis, we compare the relationships between an individual's socioeconomic risk, based on each of these measures, and potentially preventable acute care utilization., Methods: Using emergency department (ED) visit data from two academic medical centers in Boston, Massachusetts, we conducted adjusted Poisson regressions of ADI decile and NSS decile with counts of low acuity ED visits, admissions for ambulatory care sensitive conditions (ACSCs), and patients with high frequency ED utilization at the census block group (CBG) level within the greater Boston area., Results: Both NSS and ADI decile were associated with elevated rates of utilization, although the associated incidence rate ratios (IRRs) for NSS were higher than those for ADI across all three measures. NSS decile was associated with IRRs of 1.11 [95% CI: 1.10-1.12], 1.16 [1.14-1.17], and 1.22 [1.19-1.25] for ACSC admissions, low acuity ED visits, and patients with high frequency ED utilization, respectively; compared with 1.04 [1.04-1.05], 1.11 [1.10-1.11], and 1.10 [1.08-1.12] for ADI decile., Conclusion: ADI and NSS both represent effective tools to assess the potential impact of geographically-linked socioeconomic drivers of health on potentially preventable acute care utilization. NSS decile was associated with a greater effect size for each measure of utilization suggesting that this may be a stronger predictor, however, additional research is necessary to evaluate these findings in other contexts., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Most studies evaluating the adequacy of antidepressant treatment have focused on the relatively small segment of the medicated population with a diagnosis of depression. This study assessed the rates and determinants of the adequacy of antidepressant treatment among all outpatients who receive antidepressants., Methods: A retrospective analysis was conducted using pharmacy claims made by patients with a primary care physician in a managed care plan at an academic medical center from 1996 through 1999. Adequate antidepressant treatment was defined as prescription of the lowest likely effective dosage of an antidepressant for at least 90 consecutive days. Data for a total of 15,476 records and 1,550 patients were available., Results: Overall, 46 percent of the patients receiving antidepressants received minimally adequate treatment. The rates of adequate treatment were significantly higher among patients whose antidepressant prescriptions were written by both primary care physicians and psychiatrists than among patients whose antidepressants were prescribed solely by primary care physicians (61 percent versus 31 percent). Patients who had trials of SSRIs had significantly higher rates of treatment adequacy than those who had trials of tricyclic antidepressants but not SSRIs (51 percent compared with 27 percent) or trials with other antidepressants only (24 percent)., Conclusions: Pharmacy claims from all patients receiving antidepressants indicate that these drugs are prescribed in ways that are unlikely to be fully effective across the broad spectrum of patients. Adequate antidepressant treatment trials were most likely when psychiatrists collaborated with primary care physicians or other specialists and when SSRIs were used.