Management of patients on psychotropic drugs in primary care clinics

While nonpsychiatrist physicians account for the majority of prescriptions written for psychotropic drugs, little is known about the quality of their drug management strategy. We studied this issue using data from 16 academic internal medicine group practices. Data on treatment, abstracted from medical records, were compared to criteria for quality care. Eighteen percent of patients used minor tranquilizers or antidepressants. The only individual factor independently associated with use of minor tranquilizers was mental health status. Nonwhites were less likely than whites to be diagnosed as depressed or receive antidepressants, even after controlling for baseline mental and physical health status. Mental and physical health status were also independently associated with antidepressant drug use. Quality of care was low for formulating a treatment plan for either drug group and for follow-up plans for antidepressants. Documentation of an adequate treatment plan for minor tranquilizers was poorest for patients who visited a house staff or nonphysician rather than a faculty member. For antidepressants, the patients with the poorest general health status tended to have the best documentation of treatment plans.