Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study
Department of Quantitative Health Sciences
Adult; Boston; Chicago; Depressive Disorder; Fees, Medical; Female; *Group Practice; *Health Maintenance Organizations; Humans; Logistic Models; Longitudinal Studies; Los Angeles; Male; Middle Aged; Physician's Practice Patterns; *Private Practice
Biostatistics | Epidemiology | Health Services Research
We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.
JAMA. 1989 Dec 15;262(23):3298-302. Link to article on publisher's site
JAMA : the journal of the American Medical Association
Wells, Kenneth B.; Hays, Ron D.; Burnam, M. Audrey; Rogers, William H.; Greenfield, Sheldon; and Ware, John E. Jr., "Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study" (1989). Quantitative Health Sciences Publications and Presentations. 484.