What is the nature of psychiatric practice today? Who is receiving care from psychiatrists? What kind of treatments are patients receiving from psychiatrists, and how are those treatments affected by different kinds of care systems?

Those are among the questions that a burgeoning data base derived from APA's Practice Research Network (PRN) will help to answer.

Those data will in turn be crucial in presenting an accurate picture of the state of psychiatric practice to clinicians, policy makers, managed care companies, and other payers of health care insurance, making the PRN one of the most critical Association activities, said John McIntyre, M.D., chair of APA's Steering Committee on Practice Guidelines and a former APA president.

Currently consisting of 151 psychiatrists, the PRN will be expanding to 500 this year and 1,000 psychiatrists within the next two years, McIntyre said.

He urged APA members interested in joining the network, or in finding out more about it, to contact one of the PRN's regional liaisons (see end of story).

"The reality that we can now generate data about what psychiatrists do and how it is affected by reimbursement has not made an impression on the membership yet," McIntyre said.

These are data that could profoundly influence policy and financing decisions that will shape the future of psychiatry, he said.

The information derived from the research network can be used to describe the nature and course of mental disorders as well as describe psychiatric patients, treatments, and treatment settings, McIntyre emphasized.

The PRN data can also be valuable in assessing treatment outcomes and the relative effectiveness of specific treatments--and combinations of treatments--for different patient groups. These types of data are critically needed to inform day-to-day clinical decision making.

McIntyre added that despite the small number of psychiatrists who are currently members of the PRN, the network is already yielding important information.

Data gleaned from a pilot study of PRN members conducted in January 1995 revealed, for example, that the majority of patients treated by the participating 148 psychiatrists had significant psychiatric comorbidities, a fact that should be useful in dispelling the notion that psychiatrists treat "the worried well," McIntyre said.

One in five patients had at least three DSM-IV Axis I mental disorders, and approximately 54 percent had at least two co-occurring Axis I disorders, according to the pilot study.

"The reality is that patients treated by psychiatrists have significant illness," said McIntyre, highlighting the finding. "The majority have more than one Axis I disorder, and the majority of outpatients have had to be hospitalized."

McIntyre also cited data from the PRN indicating that psychiatrists are treating 5.2 new patients per week, contradicting the notion that psychiatrists have the same patients in treatment for years, he said.

Another significant preliminary finding from the PRN Pilot Study of Psychiatric Patients and Treatments indicates that PRN patients in managed care plans are less likely to receive psychotherapy in addition to medication than are PRN patients in fee-for-service insurance plans.

Thirty-eight percent of managed care patients treated by PRN psychiatrists received medications alone without individual, family, or group psychotherapy compared with 28 percent of the fee-for-service patients, according to data to be published in Psychopharmacology Bulletin. This differential remained even after adjusting for severity and principal diagnosis.

APA Deputy Medical Director Harold Alan Pincus, M.D., codirector of the PRN, echoed McIntyre in urging APA members to join the research network.

"We look forward to building on the success of these initial pilot studies," Pincus said. "We're now expanding the PRN and are in the process of developing an array of studies to assess the effectiveness of psychiatric treatments and the factors that impact the patterns and outcomes of treatments."

Want to Network With the Network?

APA is seeking psychiatrists to participate in its Practice Research Network. Members interested in receiving information about the network may contact the following network Area liaisons:

Area 1	Miguel A. Leibovich, M.D.	(617) 491-5050
Area 2	James E. Nininger, M.D.	(212) 879-8338
Area 3	Jorge A. Pereira-Ogan, M.D.	(302) 654-6353
Area 4	Bernard B. Foster, M.D.	(513) 961-8861
Area 5	Martin J. Kommor, M.D.	(304) 341-1500
Area 6	Michael Gitlin, M.D.	(310) 208-7278
Area 7	James E. Campbell, M.D.	(602) 242-6797
Minority and Underrepresented Liaison	Albert C. Gaw, M.D.	(617) 687-2615
or telephone the PRN staff at (800) 713-7123

(Psychiatric News, September 6, 1996)