Association between prescriber practices and major depression treatment outcomes

Practice variability may represent an opportunity to improve care by identifying the differences in outcomes associated with differences in practice. To characterize differences in depression treatment outcomes among individual providers in outpatient psychiatry practices and primary care practices, we examined a longitudinal cohort derived from outpatient electronic health records from two academic medical centers and six community hospitals in Eastern Massachusetts. This cohort included antidepressant-treated individuals with an ICD-9/10 diagnosis of major depressive disorder, and deidentified health care providers treating at least 10 such patients per year between 2008 and 2022. We examined the association between individual provider prescribing characteristics and proportions of treated patients who do not follow up after initial antidepressant prescription or who achieve a stable ongoing prescription. In binomial regression models, among 104 psychiatrists, greater heterogeneity in antidepressant prescribing and lesser proportion of serotonin reuptake inhibitors (SSRIs)¹ prescribed were associated with greater rates of achieving stability (for heterogeneity, adjusted odds ratio AOR, 1.55 [95 % CI, 1.22 - 2.06]; for proportion of SSRIs, AOR, 0.01 [95 % CI, 0.00-0.59]). Among 369 primary care physicians, greater volume of depression encounters per year, but not prescribing heterogeneity, was associated with greater rates of achieving stability (for encounters, AOR, 2.15 [95 % CI, 1.61 - 2.89]; for heterogeneity, AOR, 0.99 [95 % CI, 0.85 - 1.15]). Primary care and psychiatry predictors are not the same and therefore suggest potentially distinct strategies to improve clinical outcomes in each setting. Trial Registration: N/A.