by C. G. Lyketsos, M.D., M.H.S.
Maryland PRN Liaison
[June 1995; Vol. 22 No. 3]
The APA’s Practice-based Research Network (PRN) has grown by leaps and bounds since its inception in 1993. The Maryland District Branch has been actively participating in the development of the Network from its very beginning. As discussed in a November 1993 article of The Maryland Psychiatrist, this practice-based research network represents an important insurance policy for the future of psychiatry. In this time of cost cutting, it is essential for psychiatrists to demonstrate the importance of quality care and good outcomes which we accomplish. Indeed, these outcomes go well beyond symptom relief and extend to improvements in patient functioning, better compliance with health care in general, reduction in risky behaviors such as substance abuse, benefits to families, and to work environments. The APA’s PRN will be a crucial vehicle through which we will demonstrate these benefits for all to see.
Jack McIntyre, MD, during his presidency of the APA, began the PRN along with Harold A. Pincus, MD and Deborah Zarin, MD. Drs. Zarin and Pincus, along with Joyce West, MPP, provide staff support at the APA.
In its present form, the PRN is comprised of 158 psychiatrists in approximately 15 states throughout the nation. Network members are selected using a systematic method which includes random selection and word of mouth. Once identified, network members are sent a survey once or twice a year on which they are asked to describe their practice or their patients. These surveys are returned to the APA central office where data are aggregated, analyzed and disseminated.
Thus far, three surveys have been conducted. One determined the feasibility of recruiting a randomly selected sample of APA members into the Network. The second was entitled “Network Members and Their Practices”, and the third was entitled “Psychiatric Patients and Their Treatments”. In Maryland, we have participated in all three studies and have received considerable praise from the APA central office for the enthusiasm shown by network members. Nationwide, over 84% of network participants have responded to their surveys. In the most recent study, 94.9% responded! This response rate is much higher than the rates in networks in family practice and pediatrics.
The PRN has also been very successful in developing its own structure. Beginning May 1, 1995, it will be supported by the Federal Center for Mental Health Services (part of the Substance Abuse and Mental Health Services Administration) with a three-year $300,000 contract for infrastructure development. There are also encouraging reports that funding will arrive from such sources as the National Institute of Mental Health, and the New York State Office of Health. Additionally, the PRN has greatly expanded its computer capabilities at the central office so that it can rapidly communicate with network members. At present, the structure of the network is such that communication between the central office and network members is direct, but also augmented by the activities of a liaison for each of the APA areas, and by liaison within each district branch. Network members, district branch liaisons, and area liaisons are active participants in the process, helping with the planning and organization, and participating in the dissemination of the results. There will be several meetings for Network participants at the 1995 Annual Meeting in Miami.
And now some data. The most recent PRN Network study, which is still in the early stages of analysis, has generated patient level data on a systematic sample of 725 psychiatric patients nationwide. Clearly, the ability to collect data rapidly on this number of patients is one of the strengths of the PRN. There are detailed sociodemographic, diagnostic, and treatment data on a subsample of 290 patients. Early results suggest that psychiatrists are seeing patients with significant psychiatric and general co-morbidities. Fifty-two percent of patients had at least one or more Axis I - mental disorders in addition to the principle diagnosis that was the focus of clinical treatment. Thirty-nine percent had one or more Axis II - personality disorder diagnoses in addition to the principal diagnosis and 41% had one or more Axis III - general medical condition. The mean GAF (global assessment functioning) score for the sample was 56. A quarter to a third of all patients were being concurrently treated another mental health provider, most commonly a social worker or a nurse. The most frequently prescribed psychotropics were fluoxetine, sertaline and lithium. A variety of anti-depressants, anxiolitics, and neuroleptics were also being prescribed. More detail on the diagnostic profile of patients and their relationship between diagnostic profile, GAF score and treatments is pending.
A variety of activities are planned during the annual meeting for PRN members. If any members have questions about these annual meeting activities, or would like more information on the PRN, they can call Dr. Lyketsos at (410) 955-6158.