Psychologist Prescribing

To the Editor: A commentary, "Beyond Medication Errors," by Jack G. Wiggins, Ph.D. (1), in the December issue, described two randomized trials that our research group has completed (2,3). Although we appreciate the attention to our work, we should clarify that neither of the two collaborative care models used in our studies involved having psychologists or other nonphysician providers assume responsibility for prescribing medications.

Dr. Wiggins states that "Katon and associates demonstrated that collaboration between primary care physicians and psychologists significantly improved clinical outcomes in the treatment of depression over the generalist's usual care." One of the trials to which he referred (2) actually assigned patients randomly to one of two conditions—an intervention in which the psychiatrist collaborated with the patient's primary care physician and usual care. The collaborative intervention was designed to improve depression outcomes with more effective pharmacotherapy. In the second study that Dr. Wiggins referred to (3), patients were randomly assigned to either a psychologist-psychiatrist intervention or usual care. In this intervention, the psychologist provided four to six sessions of cognitive-behavioral therapy and monitored the patient's adherence to medication, antidepressant dosage, and depressive symptoms. The psychologist had weekly supervision with a psychiatrist, and the psychologist would then communicate the psychiatrist's recommendations about medication changes to the family physician. Therefore, psychologists were not managing antidepressant treatment or independently making medication suggestions in either of these trials.

Dr. Katon is affiliated with the department of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. Dr. Lin and Dr. Simon are with the Center for Health Studies at Group Health Cooperative in Seattle.