OUTPATIENT UTILIZATION PATTERNS OF INTEGRATED AND SPLIT PSYCHOTHERAPYAND PHARMACOTHERAPY FOR DEPRESSION

Objective: This exploratory study examined utilization and costs among depressed patients in two treatment models-integrated treatment, in w hich psychotherapy and pharmacotherapy were provided by a psychiatrist , and split treatment, in which pharmacotherapy was provided by a psyc hiatrist and psychotherapy by a nonphysician psychotherapist. Methods: A quasiexperimental retrospective design was used to compare claims d ata from a national managed mental health care organization for 191 pa tients in integrated treatment and 1,326 in split treatment. Results: During the 18-month study, patients receiving integrated treatment use d significantly fewer outpatient sessions and had significantly lower treatment costs, on average, than those in split treatment. Integrated treatment appeared to be associated with a pattern of utilization cha racterized by frequent treatment episodes in contrast to that of split treatment, which was characterized by more sessions with fewer breaks of 90 days or more. Conclusions: The results do not support the preva iling assumption that integrated treatment is more costly than split t reatment in a managed care network. Despite limitations in the study m ethods, the strength of these preliminary findings poses a powerful ch allenge and invites further study.