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 antide pressant treatment, little research has applied similar standards to psychi atric practice. This study compares baseline characteristics, process of ca re, 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 i nitial antidepressant prescriptions from psychiatrists (n=165) and primary care physicians (n=204) completed a baseline assessment, including the Stru ctured Clinical Interview for DSM-IV depression module, a 20-item depressio n assessment from the Symptom Checklist-90, and the Medical Outcomes Survey 36-Item Short-Form Health Survey functional status questionnaire. All meas ures were repeated after 2 and 6 months. Computerized data were used to ass ess antidepressant refills and follow-up visits over 6 months. Results: At baseline, psychiatrists' patients reported slightly higher leve ls of functional impairment and greater prior use of specialty mental healt h 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% v s 26% for primary care physicians' patients. The proportion receiving antid epressant medication at an adequate dose for 90 days or more was similar (4 9%;, vs 48%). The 2 groups showed similar rates of improvement in all measu res of symptom severity and functioning. Conclusions: In this sample, clinical differences be tween 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 comm on in specialty practice. Possible selection bias limits any conclusions ab out relative effectiveness or cost-effectiveness.