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Related Experiment Videos

Variation in ECT use in the United States

R C Hermann1, R A Dorwart, C W Hoover

  • 1Malcolm Wiener Center for Social Policy, John F. Kennedy School of Government, Harvard University, Cambridge, Mass., USA.

The American Journal of Psychiatry
|June 1, 1995
PubMed
Summary

Electroconvulsive therapy (ECT) use varied significantly across U.S. metropolitan areas. Factors like physician availability and state regulations influenced these ECT utilization rates, impacting patient access.

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Area of Science:

  • Psychiatry and Healthcare Services Research

Background:

  • Electroconvulsive therapy (ECT) is a medical procedure, but its utilization rates show considerable geographic variation.
  • Understanding the factors driving these disparities is crucial for equitable healthcare access.

Purpose of the Study:

  • To measure the variation in ECT utilization rates across U.S. metropolitan statistical areas (MSAs).
  • To determine the association between ECT use variation and healthcare system characteristics, demographics, and state regulations.

Main Methods:

  • Utilized data from the American Psychiatric Association's (APA) 1988-1989 Professional Activities Survey.
  • Estimated ECT utilization rates for MSAs and employed multiple regression analysis.
  • Assessed the influence of provider, demographic, and regulatory factors on ECT use variation.

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Main Results:

  • ECT use was reported in 202 out of 317 MSAs, with annual rates ranging from 0.4 to 81.2 patients per 10,000 population.
  • No ECT use was documented in 115 MSAs.
  • Key predictors of ECT use variation included the number of psychiatrists, primary care physicians, private hospital beds per capita, and state regulatory stringency.

Conclusions:

  • ECT utilization rates are highly variable and higher than many medical/surgical procedures, suggesting potential access limitations in some urban areas.
  • Identified predictors offer insights into strategies for improving ECT access.
  • The wide variation indicates a lack of professional consensus on ECT use, highlighting the need for more data on treatment effectiveness to foster broader agreement and standardize clinical practices.