Effect of communicating depression severity on physician prescribing patterns: findings from the Clinical Outcomes in MEasurement-based Treatment (COMET) trial

• Published in: General hospital psychiatry 2012-03, Vol.34 (2), p.105-112
• Main Authors: Chang, Trina E., M.D., M.P.H, Jing, Yonghua, Ph.D, Yeung, Albert S., M.D, Brenneman, Susan K., Ph.D, Kalsekar, Iftekhar, Ph.D, Hebden, Tony, Ph.D, McQuade, Robert, Ph.D, Baer, Lee, Ph.D, Kurlander, Jonathan L., M.S, Watkins, Angela K., M.A, Siebenaler, Jean A., M.D, Fava, Maurizio, M.D
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Antidepressive Agents - therapeutic use; Biological and medical sciences; Depression; Depressive disorder; Depressive Disorder, Major - classification; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - physiopathology; Feedback; Female; Humans; Interviews as Topic; Male; Medical sciences; Mood disorders; Outcome Assessment (Health Care) - methods; Practice Patterns, Physicians; Prescribing pattern; Primary Health Care; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Questionnaires; Self-report; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2011.12.003

Abstract Objective In this secondary analysis from the Clinical Outcomes in MEasurement-based Treatment trial (COMET), we evaluated whether providing primary care physicians with patient-reported feedback regarding depression severity affected pharmacological treatment patterns. Method Intervention-arm physicians received their patients' 9-item Patient Health Questionnaire scores monthly. Odds of having no change in antidepressant treatment during the 6-month study period were calculated. Relationships between depression symptom status (partial or nonresponse) at month 3 and treatment changes in months 3 through 6 were assessed. Results Among 503 intervention and 412 usual care (UC) patients with major depressive disorder, most received antidepressant monotherapy at baseline (79.4% UC vs. 88.4% intervention; P =.047). Few switched their baseline antidepressant (17.4%), increased their dose (12.4%) or augmented with a second medication (2%). Odds of having no change in antidepressant therapy did not differ significantly between study arms (odds ratio 1.21; 95% confidence interval 0.78–1.88; P =.392). Few month 3 partial or nonresponders had a regimen change over the following 3 months; the study arms did not differ significantly (partial responders: 4.1% UC vs. 7.7% intervention; P =.429; nonresponders: 14.6% UC vs. 15.9% intervention; P =.888). Conclusions Among depressed patients treated in primary care, little active management was observed. The lack of treatment modification for the majority of partial and nonresponders was notable.