Clinician Specialty and Treatment Style for Depressed Outpatients With and Without Medical Comorbidities
Lisa S. Meredith, PhD;
Kenneth B. Wells, MD, MPH;
Patti Camp, MS
Arch Fam Med. 1994;3(12):1065-1072.
The advent of clinical practice guidelines for the management of depression increases the importance of understanding variation across clinician specialty groups in treatment styles for depression and the role of medical comorbidities.
Data are reported by clinicians (N=470) and patients (N=2545). Multiple regression was used 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 different medical comorbidities.
Relative to other primary care specialists, family physicians had the strongest preferences for both counseling and prescribing antidepressants for depressed patients. Family physicians reported preferences for treating with antidepressants that were similar to those of psychiatrists. However, in actual practice, medication use was higher among the patients of psychiatrists than those of family physicians. Mental health care specialists reported the strongest counseling preferences and provided the most counseling in actual practice, compared with general medicine physicians. Internists and subspecialists had similar preferences for prescribing antidepressants, but, compared with internists, subspecialists had lower preferences for counseling. Clinician preferences for counseling were similar for depressed patients with or without medical comorbidities, but preferences for prescribing antidepressants were lowest for patients with depression and myocardial infarction, compared with other patient groups.
Measures of clinician treatment style for depression are good proxies for counseling but not for prescribing practices. Among general medical physicians, family physicians have the strongest reported preferences in treating depression but, especially in terms of medication therapy, do not always follow those preferences. Preferred treatments of patients with and without medical comorbidities were similar. Findings have implications for improving the quality of treatment of depressed patients.
From RAND, Santa Monica, Calif (Drs Meredith and Wells and Ms Camp), and the Department of Psychiatry and Biobehavioral Sciences, University of CaliforniaLos Angeles (UCLA) Neuropsychiatric Institute and Hospital, UCLA School of Medicine (Dr Wells).
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