Why don't psychiatrists use scales to measure outcome when treating depressed patients?

A survey of psychiatrists in the United Kingdom found that only a minority routinely used standardized measures to assess outcome when treating depression and anxiety disorders. The goals of the present study were to determine how frequently psychiatrists in the United States use scales to measure outcome when treating depressed patients and, for those clinicians who do not regularly use such scales, to ascertain the reasons for the lack of use.

The subjects were 314 psychiatrists who attended a continuing medical education conference in California, Massachusetts, New York, or Wisconsin in 2006 or 2007. Prior to a lecture, the subjects completed a questionnaire that included 2 questions regarding the use of rating scales to monitor outcome when treating depression.

More than 80% of the psychiatrists indicated that they did not routinely use scales to monitor outcome when treating depression. The most frequent reasons psychiatrists gave for not using scales were that they did not believe scales would be clinically helpful, that scales take too much time to use, and that they were not trained in the use of such measures.

The majority of psychiatrists indicated that they do not routinely use standardized measures to evaluate outcome when treating depressed patients. The Centers for Medicare and Medicaid Services' Physician Quality Reporting Initiative is intended to improve quality of care by providing physicians financial incentives to document outcomes reflecting best practices. If standardized outcome assessment is to assume increasing importance in this country, either educational efforts or payor mandates, or both, will be necessary to change clinicians' behavior.