COUNSELING TYPICALLY PROVIDED FOR DEPRESSION - ROLE OF CLINICIAN SPECIALTY AND PAYMENT SYSTEM

Background: To assess how current policy trends may affect the use of counseling for depression, we examined the variation in the use of cou nseling and usual clinician counseling style for depression across spe cialty sectors (psychiatry, psychology, and general medicine) and reim bursement type (fee-for-service or prepaid). Methods: Three types of o bservational data from the RAND Medical Outcomes Study: (1) patient-re ported demographics, depressive symptoms, clinical status, and percept ions about participation style; (2) clinician reports of counseling du ring specific patient encounters; and (3) clinician reports of the usu al counseling and interpersonal style across patients who were seen in a practice. Results: While almost all depressed patients who were bei ng treated by mental health specialists received brief counseling for at least 3 minutes, less than half of the depressed patients in the ge neral medical sector received such counseling-even for those patients with a current depressive disorder. Counseling rates were lower under prepaid than fee-for-service care in general medical practices. Psychi atrists relied more on psychodynamic approaches, and psychologists rel ied more on behavioral therapies relative to each other, but both spec ialty groups provided longer sessions and used more formal psycho-ther apeutic techniques (eg, interpretation) than did general medical clini cians. Clinicians who were treating more patients who had prepaid plan s reported a lower proclivity for face-to-face counseling, and they sp ent less time when they were counseling patients compared with clinici ans who were treating more patients who had fee-for-service plans; how ever, these differences were not large. Conclusion: The use of counsel ing in the usual care for depression varied by both specialty and paym ent system, while the usual clinician counseling style differed marked ly by specialty, but only slightly by payment system.