Association between prescriber practices and major depression treatment outcomes

Area of Science:

• Clinical Psychiatry
• Health Services Research
• Pharmacotherapy

Background:

• Practice variability in mental healthcare can highlight opportunities for improving patient outcomes.
• Understanding how individual provider practices influence depression treatment effectiveness is crucial for optimizing care.
• Outpatient electronic health records offer a valuable resource for analyzing real-world treatment patterns.

Purpose of the Study:

• To investigate how individual provider prescribing characteristics correlate with depression treatment outcomes in outpatient settings.
• To compare these associations between psychiatrists and primary care physicians.
• To identify distinct predictors of treatment success in each specialty.

Main Methods:

• Analysis of a longitudinal cohort from electronic health records (2008-2022) including patients with major depressive disorder treated with antidepressants.
• Examination of provider prescribing heterogeneity and the proportion of serotonin reuptake inhibitors (SSRIs) used.
• Binomial regression models to assess the association between provider characteristics and patient follow-up or stable prescriptions.

Main Results:

• Among psychiatrists, greater prescribing heterogeneity and a lower proportion of SSRIs were linked to higher rates of achieving stable antidepressant prescriptions.
• For primary care physicians, a higher volume of depression encounters per year, but not prescribing heterogeneity, was associated with improved patient stability.
• Predictors for treatment outcomes differed significantly between psychiatry and primary care settings.

Conclusions:

• Provider-specific prescribing behaviors influence depression treatment outcomes, with distinct factors relevant to psychiatrists and primary care physicians.
• Strategies to improve depression care should be tailored to the specific setting and provider type.
• Further research into practice variability can guide the development of targeted interventions to enhance patient stability and treatment effectiveness.