title: Effect of communicating depression severity on physician prescribing patterns: findings from the Clinical Outcomes in MEasurement-based Treatment (COMET) trial.
abstract: OBJECTIVE
  In this secondary analysis from the Clinical Outcomes in MEasurement-based Treatment trial (COMET), we evaluated whether providing primary care physicians with patient-reported feedback regarding depression severity affected pharmacological treatment patterns.
  
  
  METHODS
  Intervention-arm physicians received their patients' 9-item Patient Health Questionnaire scores monthly. Odds of having no change in antidepressant treatment during the 6-month study period were calculated. Relationships between depression symptom status (partial or nonresponse) at month 3 and treatment changes in months 3 through 6 were assessed.
  
  
  RESULTS
  Among 503 intervention and 412 usual care (UC) patients with major depressive disorder, most received antidepressant monotherapy at baseline (79.4% UC vs. 88.4% intervention; P=.047). Few switched their baseline antidepressant (17.4%), increased their dose (12.4%) or augmented with a second medication (2%). Odds of having no change in antidepressant therapy did not differ significantly between study arms (odds ratio 1.21; 95% confidence interval 0.78-1.88; P=.392). Few month 3 partial or nonresponders had a regimen change over the following 3 months; the study arms did not differ significantly (partial responders: 4.1% UC vs. 7.7% intervention; P=.429; nonresponders: 14.6% UC vs. 15.9% intervention; P=.888).
  
  
  CONCLUSIONS
  Among depressed patients treated in primary care, little active management was observed. The lack of treatment modification for the majority of partial and nonresponders was notable.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. techang@partners.org
authors.forename: Trina E
authors.initials: TE
authors.lastname: Chang
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Jing
authors.forename: Albert S
authors.initials: AS
authors.lastname: Yeung
authors.forename: Susan K
authors.initials: SK
authors.lastname: Brenneman
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Kalsekar
authors.forename: Tony
authors.initials: T
authors.lastname: Hebden
authors.forename: Robert
authors.initials: R
authors.lastname: McQuade
authors.forename: Lee
authors.initials: L
authors.lastname: Baer
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Kurlander
authors.forename: Angela K
authors.initials: AK
authors.lastname: Watkins
authors.forename: Jean A
authors.initials: JA
authors.lastname: Siebenaler
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology*; D005246:Feedback; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents