The quality of patient care in the treatment of dysthymia within a managed care environment

The study addressed the quality of treatment and treatment outcome within a retrospective insurance claims database comprised of dysthymic patients. Five different types of insurance plans were represented in the database and analyses considered each plan individually, as well as within the context of a dichotomous HMO versus non-HMO variable. The statistical analyses revealed that non-HMO insurance plan members reported significantly more psychotherapy visits than their chronically depressed counterparts in an HMO plan, with enrollees in the Point of Service Plan with Capitation reporting the most psychotherapy sessions. The treatment response variable employed here was not associated with the HMO vs. non-HMO dichotomy. The study also sought to identify the optimal number of psychotherapy sessions necessary to produce an improved treatment response. However, due to statistical insignificance within the regression models this objective could not be addressed. A post-hoc exploratory analysis revealed that ≥17 psychotherapy sessions plus medication predicted an improved treatment response when compared to medication alone or <17 psychotherapy sessions plus medication. Several other variables including comorbid psychiatric/medical disorders and the use of mental health specialists were also associated with the treatment response variable. One conclusion taken from these data is that the current research literature is not yet informing real-world clinical practice with regards to the psychotherapeutic care of dysthymic patients.