Psych Congress NetworkClinician-Level Differences Significantly Affect MDD Prescribing, Outcomes

Clinician Specialties and Practice Settings Shape Antidepressant Prescribing Patterns and Treatment Outcomes in Major Depressive Disorder

A recent study published in JAMA Psychiatry reveals significant variations in antidepressant prescribing patterns and treatment outcomes for patients with major depressive disorder (MDD) across different clinician groups. The research, which analyzed data from more than 11,000 clinicians across various specialties, highlights the importance of considering clinician-level factors alongside patient characteristics when studying antidepressant prescribing in real-world settings.

Key Points:

• The study utilized electronic health record data from 2 large academic medical centers and 6 community hospitals in eastern Massachusetts.
• Researchers focused on 11,934 clinicians who billed at least 10 MDD diagnoses annually between 2008 and 2022.
• Unsupervised machine learning identified 10 distinct clinician clusters based on International Classification of Diseases codes.
• Clusters corresponded to outpatient psychiatry, oncology, obstetrics, and primary care.
• Significant variability was observed between clusters in the proportions of prescribed antidepressant classes (SSRIs, SNRIs, and TCAs).
• The number of specific antidepressants prescribed differed substantially across clusters.
• Clinicians in cancer and kidney disease clusters had the highest rate of antidepressant prescribing, similar to outpatient psychiatry.
• General psychiatry cluster exhibited the greatest heterogeneity in prescribing across antidepressant medication classes.
• Other clusters showed more limited prescribing patterns.
• Patient outcomes varied significantly between clinician clusters:
  • Patients lost to follow-up ranged from 27% to 69%
  • Patients achieving stable treatment ranged from 22% to 42%
• Clinician clusters were strongly associated with treatment outcomes.
• Researchers advise including information on treatment setting and clinician-level factors in studies of antidepressant prescribing and efforts at risk stratification or personalization of care.

HCN Medical Memo
This study emphasizes the need for physicians to consider their own practice setting and specialty when evaluating antidepressant prescribing patterns and treatment outcomes. Recognizing these clinician-level differences may lead to more personalized and effective care strategies for patients with major depressive disorder.

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