Abstract
Primary care providers are the biggest prescribers of psychopharmacological medications. In this non-randomized retrospective examination, we asked whether primary care patients receiving behavioral health interventions with and without concurrent pharmacological treatments showed differential symptom improvement. Participants (79.4% women, 61.5% Hispanic, M age = 41.68, SD = 13.50) were 431 primary care patients referred to behavioral health with a primary concern of depression at one of three federally qualified health centers. Thirty-three percent of patients initiated or had an increase in pharmacotherapy concurrently with behavioral therapy; 26.9% had no change in medication during the episode of care, and 39.7% had no concurrent psychotropic medication prescribed during the episode of care. One-way analyses of variance revealed patients in the no medication group had higher global functioning, as measured by Global Assessment of Functioning (GAF) scores, than patients who were taking medication, or who initated or had an increase in medication. There was a significant main effect of time, where patients had significantly higher GAF scores during their last session in comparison to the first session. All three patient groups experienced comparable improvements in GAF scores, but patients in the initiated/increased medication group were significantly more likely to terminate behavioral health treatment prematurely. Results suggest primary care patients experience improvements in functioning across an episode of behavioral health care, even without concurrent psychotropic medication use.
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Acknowledgements
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number D40HP29826-01-01 (PI: Ana J. Bridges). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government. The authors are grateful to Kathy Grisham, John Reynolds, and Brian Smith at Community Clinic NWA for collaborating with us in providing integrated behavioral health care services and for their technical assistance with data extraction from electronic medical records.
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The first author receives supervision/consultation fees from the FQHC where data collection took place. All research reported here was approved by the University IRB and by the Executive Director of the FQHC where data collection took place. All patients seen at the FQHC sign a consent form, updated yearly, allowing their medical record to be used for research and program evaluation purposes.
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Bridges, A.J., Ledesma, R.J., Dueweke, A.R. et al. A Retrospective Examination of Symptom Improvements in Primary Care Patients Receiving Behavior Therapy With and Without Concurrent Pharmacotherapy. J Clin Psychol Med Settings 27, 582–592 (2020). https://doi.org/10.1007/s10880-019-09642-2
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DOI: https://doi.org/10.1007/s10880-019-09642-2