Does the Level of Care Explain Primary Care Depression Treatment Outcomes? Results from the PRISM-E Study

The primary objective of this research was to discover whether the presence of guideline level care delivered to patients with major depressive disorder in the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for Elderly) study may explain why better outcomes were achieved for the group treated with an enhanced referral model versus those treated in an integrated care model, even though patients were more engaged in the integrated model. The PRISM-E study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings. Using only those patients with major depressive disorder (MDD), treatment episodes indicating the presence of guideline level care were constructed to explain differences in 6-month outcomes between those assigned to referral care and those assigned to integrated care for depression treatment. Initial findings show that patients with MDD only in the integrated setting had an average of 3.6 total treatment visits during the 6-month treatment period, as compared to a mean of 2.0 for the referral group. For those patients dually diagnosed with MDD and anxiety, the integrated group had an average of 4 visits while those in the referral group had an average of 2.7. The enhanced referral group had significantly more visits to a psychiatrist. There were no significant differences in the utilization or augmentation of antidepressants during the study period. Further analyses will explore if differences in combination treatments (both psychotherapy and pharmacology) explain significant differences in 6-month outcomes.