Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians.
BACKGROUND
While many studies describe deficiencies in primary care antidepressant treatment, little research has applied similar standards to psychiatric practice. This study compares baseline characteristics, process of care, and outcomes for managed care patients who received new antidepressant prescriptions from psychiatrists and primary care physicians.


METHODS
At a prepaid health plan in Washington State, patients receiving initial antidepressant prescriptions from psychiatrists (n = 165) and primary care physicians (n = 204) completed a baseline assessment, including the Structured Clinical Interview for DSM-IV depression module, a 20-item depression assessment from the Symptom Checklist-90, and the Medical Outcomes Survey 36-Item Short-Form Health Survey functional status questionnaire. All measures were repeated after 2 and 6 months. Computerized data were used to assess antidepressant refills and follow-up visits over 6 months.


RESULTS
At baseline, psychiatrists' patients reported slightly higher levels of functional impairment and greater prior use of specialty mental health care. During follow-up, psychiatrists' patients made more frequent follow-up visits, and the proportion making 3 or more visits in 90 days was 57% vs 26% for primary care physicians' patients. The proportion receiving antidepressant medication at an adequate dose for 90 days or more was similar (49% vs 48%). The 2 groups showed similar rates of improvement in all measures of symptom severity and functioning.


CONCLUSIONS
In this sample, clinical differences between patients treated by psychiatrists and primary care physicians were modest. Shortcomings in depression treatment frequently noted in primary care (inadequate follow-up care and high rates of inadequate antidepressant treatment) were also common in specialty practice. Possible selection bias limits any conclusions about relative effectiveness or cost-effectiveness.
Simon
G E
GE
Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA. simon.g@ghc.org
Von Korff
M
M
Rutter
C M
CM
Peterson
D A
DA
D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010821:Physicians, Family / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*; D011570:Psychiatry / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014861:Washington
D000928:Antidepressive Agents