title: Differences in prescribing patterns for anxiety and depression between General Internal Medicine and Family Medicine.
abstract: BACKGROUND
  Depression and anxiety are routinely managed by physicians in Family Medicine (FM) or General Internal Medicine (GIM). Because FM requires more behavioral health training than GIM, we sought to determine if prescribing patterns for patients with anxiety, depression, or both differed between FM vs. GIM providers.
  
  
  METHODS
  In a cross-sectional design, patient data and provider type were obtained from 2008 to 2013 electronic medical record patient data registry (n=27,225 (FM=10,994, GIM=16,231)) Prescription orders were modeled for specific benzodiazepines and antidepressants and by drug class. Covariates included gender, age, race, marital status and comorbidity index. Separate logistic regression models were computed, before and after adjusting for covariates, to estimate the odds of FM vs. GIM providers prescribing benzodiazepine or antidepressant medication to patients with anxiety, depression, and both disorders.
  
  
  RESULTS
  After adjusting for covariates, patients with anxiety alone, depression alone, and both had significantly greater odds of receiving an antidepressant (OR=2.08;95%CI:1.46-2.96, OR=2.13;95%CI:1.48-3.06, and OR=2.26;95%CI:1.09-4.66, respectively) if treated by FM vs. GIM. Benzodiazepine prescription did not differ by physician type.
  
  
  CONCLUSIONS
  It is not known if results will generalize to other regions of the United States.
  
  
  CONCLUSIONS
  Patients with anxiety, depression, and both seen by FM providers, as compared to GIM providers, are more likely to receive antidepressant medications. Further investigation into the determinants of these differences is warranted. Under-treatment in GIM may result in less advantageous outcomes.
authors.affiliation: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States. Electronic address: brielerj@slu.edu.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Brieler
authors.affiliation: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.affiliation: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States.
authors.forename: Joanne
authors.initials: J
authors.lastname: Salas
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy*; D001569:Benzodiazepines / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D001569:Benzodiazepines
keywords: Antidepressants; Anxiety; Depression; Primary care; Psychopharmacology