Clinician-Level Differences Significantly Affect MDD Prescribing, Outcomes
Antidepressant prescribing patterns and outcomes for patients with major depressive disorder (MDD) vary significantly between prescriber groups, suggest study findings published in JAMA Psychiatry.
“While abundant work has examined patient-level differences in antidepressant treatment outcomes, little is known about the extent of clinician-level differences,” wrote first author Sarah Rathnam, MS, of the Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, and coauthors in the study background. “Understanding these differences may be important in the development of risk models, precision treatment strategies, and more efficient systems of care.”
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The cohort study used electronic health record data from 2 large academic medical centers and 6 community hospitals, including their outpatient sites, in eastern Massachusetts. Researchers focused on 11,934 deidentified clinicians who billed at least 10 diagnoses of MDD annually between 2008 and 2022.
Unsupervised machine learning of data identified 10 clinician clusters based on International Classification of Diseases codes, according to the study. The distinct clusters corresponded to outpatient psychiatry, oncology, obstetrics, and primary care.
Significant variability occurred between the clusters as to the proportions of prescribed selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, and tricyclic antidepressants. The number of specific antidepressants prescribed also differed substantially.
"While most investigations of antidepressant prescribing focus on individual clinics or general psychiatry, clinicians in the cancer and kidney disease clusters had the highest rate of antidepressant prescribing, similar to that of outpatient psychiatry after excluding nonprescribing clinicians," clinicians wrote. "As anticipated, our analyses also demonstrate that clinicians in the general psychiatry cluster exhibited the greatest heterogeneity of prescribing across antidepressant medication classes, with other clusters showing more limited prescribing patterns."
Regarding outcomes, clinician clusters varied in patients lost to follow-up, which ranged from 27% to 69% depending on the cluster, and patients who achieved stable treatment, which ranged from 22% to 42%. Analysis showed clinician clusters were markedly linked with outcomes of treatment.
“Studies of antidepressant prescribing in real-world settings, and efforts at risk stratification or personalization of care, should include information on treatment setting and other clinician-level factors alongside individual patient characteristics,” researchers advised.
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