Improving the precision of primary care physician self-report of antidepressant prescribing.
BACKGROUND
Methods to select physicians most likely to benefit from educational interventions to improve the outcome of depression have not been adequately developed.


OBJECTIVE
The purpose of this study was to identify a combination of primary care provider (PCP) self-report questions to improve the precision of PCP estimates of actual antidepressant prescribing as a potential tool for PCP selection.


METHODS
The total number of new and refill antidepressant prescriptions written by 124 PCPs and actually filled at pharmacies over a 2-year period were matched with telephone survey results of these PCPs completed before the 2-year period. Multiple regression techniques were used to identify a set of variables that improved upon PCPs' self-report of prescriptions.


RESULTS
The mean for PCP-reported antidepressant prescriptions written in the last week was 7.8 (+/-11.2). The average weekly prescriptions actually filled was 6.72 (+/-5.65). Most survey variables were significantly correlated with antidepressant prescriptions. The final model included 6 variables that explained 52% of the variance in prescriptions. In addition to PCP-reported number of antidepressants prescribed, average number of primary care patients seen per week and number of patients covered by managed care were directly related to the volume of prescriptions. PCP age, percentage of patients referred immediately without treatment, and mental health services being too far away were inversely related.


CONCLUSIONS
PCP self-reports on antidepressant prescribing are reasonably accurate proxies of actual prescribing. The precision of estimates of actual prescribing can be improved by considering practice structural and financial characteristics.
Oxman
T E
TE
Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. oxman@dartmouth.edu
Korsen
N
N
Hartley
D
D
Sengupta
A
A
Bartels
S
S
Forester
B
B
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D015203:Reproducibility of Results; D014481:United States
D000928:Antidepressive Agents