Clinician Specialty and Treatment Style for Depressed Outpatients with and Without Medical Comorbidities
Published in: Archives of Family Medicine, v. 3, no. 12, Dec. 1994, p. 1065-1072
Posted on RAND.org on December 31, 1993
Presents data on the treatments received by over 2,000 depressed patients enrolled in the Medical Outcomes Study (MOS) and the 470 clinicians who treated them. It uses multivariate analysis to compare the treatment styles (counseling and prescribing antidepressants) of family physicians with those of psychiatrists, medical subspecialists, internists, psychologists, and other therapists for depressed patients with various medical comorbidities. Based on physician surveys, the study concluded that, among primary care specialists, family physicians showed the strongest preferences for both counseling and prescribing antidepressants for depressed patients. In fact, family physicians reported preferences for treatment with antidepressants that were similar to preferences reported by psychiatrists. In actual practice, however, medication use was higher among the patients of psychiatrists than among those of family physicians. Mental health care specialists reported the strongest counseling preferences and provided the most counseling in actual practice, compared with all general medicine physicians. The article concludes that measures of clinical treatment style for depression are good proxies for counseling but not for prescribing practices. To improve care for patients with depression, it will be necessary to change physicians' preferences regarding treatment and counseling and, at the same time, make sure that preferences regarding treatment are carried out in actual practice.