[February 1996; Vol. 23 No. 1]
Earlier this year, 10 Maryland Psychiatric Society members participated in the APA Practice Research Network (PRN) Study of Psychiatric Patients and Their Treatments. The primary purpose of the pilot study was to learn more about psychiatric patients and the treatments they receive by collecting detailed patient-level data on clinical practice patterns. The study also pilot tested a simple method of systematically selecting patients and methods to facilitate the conduct of network studies.
The study was conducted nationwide in 31 states as well as Puerto Rico. It was carried out by more than 150 APA members who completed a 21-page data collection instrument that collected data on the sociodemographic characteristics, diagnoses and treatments provided to a systematically selected sample of five patients. Dr. Jorge Pereira-Ogan, the Area 3 PRN Liaison, coordinated the implementation of the study which received a 95% response rate. Dr. Constantine Lyketsos, the Maryland PRN DB liaison also assisted in coordinating the study. Deborah A. Zarin, M.D., Medical Director of the PRN stated, “Our initial data analyses indicate that the quality, integrity and completeness of the data are excellent.”
Although this pilot study utilized a convenience sample of psychiatrists that do not necessarily represent the universe of psychiatrists in the United States, the patients of PRN members appear to have similar diagnostic and demographic characteristics when compared to patients of APA members in general. The majority of patients in this study sample had significant psychiatric and general medical comorbidities. For example, one in five patients had three or more Axis I mental disorders. Thirty-nine percent of the patients had one or more Axis II personality disorders in addition to the principal disorder; and 41% had one or more Axis III general medical disorders. The mean GAF score for the sample was 56; patients who were treated in inpatient settings had a mean GAF score of 39 while patients treated in outpatient settings had a mean GAF of 62.
The most common treatments provided by the psychiatrists during the treatment visit were psychiatric/medical management (65%), individual psychotherapy (53%), and medication prescriptions/monitoring (51%). Ninety percent of the patients received at least one psychotropic medication with the most common agent being fluoxetine. This psychotropic was prescribed for 22% of the patients. Our results showed that a significant proportion of the patient sample received mental health treatments from other providers. Twenty-four percent of outpatients received individual psychotherapy from another provider.
Further analysis of the study data is now underway. The APA Office of Research is currently examining the clinical treatment patterns by disorder, severity of illness, setting, payment and health plan type. These data will be increasingly valuable as the Network sample size is expanded. This expansion will provide the statistical power necessary to study relatively small sub-groups, such as patients with schizophrenia and a substance related disorder who are receiving a specific antipsychotic agent.
For more information on the APA Practice Research Network please contact the Area 3 PRN Liaison Jorge Pereira-Ogan, M.D. at (302) 654-6353.
Many Thanks to the Maryland PRN Members Who Participated in The Study:
Thomas E. Allen, M.D.
Sigmund A. Amitin, M.D.
Lois M. Conn, M.D.
Victor Ferrans, M.D.
Arthur M. Hildreth, M.D.
Geetha Jayaram, M.D.
Lee Crandall Park, M.D.
Lex B. Smith, M.D.
Anne M. Stoline, M.D.
Arthur M. Warwick, M.D.