Association between Physicians' Adherence to a Pharmacotherapy Guideline and Continuity of Care for Patients with Depression and/or Anxiety Disorder.

OBJECTIVE The aim of the paper is to investigate the association between physicians' adherence to a pharmacotherapy guideline and continuity of care for patients with depressive and/or anxiety disorders in a collaborative care program. METHODS This retrospective observational study was conducted using medical records of subjects suffering from depression and/or anxiety disorder visited by 26 general practitioners (GP) working with  Community Mental Health Center (CMHC), who run a collaborative care program in Tehran, Iran. All patients were visited by a general practitioner in private offices from November 2010 to May 2013. A scoring system was utilized to assess physicians' adherence to the pharmacotherapy guideline using medical records. Patients' continuity of care was calculated based on the number of days of being in the collaborative care program. To investigate the association between physicians' adherence to the guideline and the patients' continuity of care, univariate logistic regression analysis, multiple logistic regression analysis and parametric survival analysis were performed using Stata version 11. RESULT  A total of 3,338 patients were studied. Their mean age was 37 years and 81.6% were female. Being treated by a particular GP was an important factor in patients with depressive and/or anxiety diagnosis as well as having both diagnoses. Furthermore, higher score of adherence to the guideline was associated with less continuity of care in depressive patients. CONCLUSION Being treated by certain GPs is an effective way of retention of patients in the treatment. The results demonstrate that patients with guideline-based pharmacotherapy need to be told about continuity of care in community mental health program.