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Article
December 15, 1989

Detection of Depressive Disorder for Patients Receiving Prepaid or Fee-for-Service CareResults From the Medical Outcomes Study

Author Affiliations

From The RAND Corp, Santa Monica, Calif (Drs Wells, Hays, Burnam, Rogers, Greenfield, and Ware); Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute and Hospital, UCLA School of Medicine, Los Angeles, Calif (Dr Wells); and Institute for the Improvement of Medical Care and Health, New England Medical Center Hospitals, Boston, Mass (Drs Greenfield and Ware).

From The RAND Corp, Santa Monica, Calif (Drs Wells, Hays, Burnam, Rogers, Greenfield, and Ware); Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute and Hospital, UCLA School of Medicine, Los Angeles, Calif (Dr Wells); and Institute for the Improvement of Medical Care and Health, New England Medical Center Hospitals, Boston, Mass (Drs Greenfield and Ware).

JAMA. 1989;262(23):3298-3302. doi:10.1001/jama.1989.03430230083030
Abstract

We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.

(JAMA. 1989;262:3298-3302)

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