Variation in ECT use in the United States.

OBJECTIVE The authors measured the variation in ECT utilization rates across 317 metropolitan statistical areas of the United States and determined to what degree this variation is associated with health care system characteristics, demographic factors, and the stringency of state regulation of ECT. METHOD Data from APA's 1988-1989 Professional Activities Survey were used to estimate ECT utilization rates for the metropolitan statistical areas. Multiple regression analysis was used to determine the relative influence of provider, demographic, and regulatory factors on variation in ECT use across areas. RESULTS Among the psychiatrists surveyed, 17,729 reported treating 4,398 patients with ECT during the study period. No ECT use was reported in 115 metropolitan statistical areas. Among the remaining 202 metropolitan statistical areas, annual ECT use varied from 0.4 to 81.2 patients per 10,000 population. The strongest predictors of variation in ECT use across metropolitan statistical areas were the number of psychiatrists, number of primary care physicians, number of private hospital beds per capita, and stringency of state regulation of ECT. CONCLUSIONS Rates of ECT use were highly variable, higher than for most medical and surgical procedures. In some urban areas, access to ECT appears limited. Predictors of variation in ECT rates have implications for expanding access to the procedure. The extent of variation suggests psychiatrists continue to lack consensus regarding the use of ECT. Better data on the effectiveness of psychiatric treatments may lead to a broader professional consensus and may narrow variations in clinical practices.

[1]  Ellwood Pm,et al.  Shattuck Lecture--outcomes management. A technology of patient experience. 1988. , 1997, Archives of pathology & laboratory medicine.

[2]  M. Olfson,et al.  Pharmacotherapy in outpatient psychiatric practice. , 1994, The American journal of psychiatry.

[3]  John E. Wennberg,et al.  Geographic Variation in Expenditures for Physicians' Services in the United States , 1993 .

[4]  M. Wilson,et al.  DSM-III and the transformation of American psychiatry: a history. , 1993, The American journal of psychiatry.

[5]  W. Fenton,et al.  A national study of psychiatrists' professional activities. , 1992, The American journal of psychiatry.

[6]  Gary S. Rogers,et al.  Diagnosis and Treatment of Early Melanoma: NIH Consensus Development Panel on Early Melanoma , 1992 .

[7]  M. Zimmerman,et al.  Consumers' attitudes toward DSM-III and DSM-III-R: a 1989 survey of psychiatric educators, researchers, practitioners, and senior residents. , 1992, Comprehensive psychiatry.

[8]  J. Pippard.  Audit of Electroconvulsive Treatment in two National Health Service Regions , 1992, British Journal of Psychiatry.

[9]  M. Fink,et al.  Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States. , 1991, The Psychiatric clinics of North America.

[10]  A. Nierenberg.  Treatment choice after one antidepressant fails: a survey of northeastern psychiatrists. , 1991, The Journal of clinical psychiatry.

[11]  D. Shaffer,et al.  Child psychiatrists' views of DSM-III-R: a survey of usage and opinions. , 1991, Journal of the American Academy of Child and Adolescent Psychiatry.

[12]  J Holahan,et al.  Area variations in selected Medicare procedures. , 1990, Health affairs.

[13]  R. Rosenheck,et al.  Regional variation in patterns of inpatient psychiatric care. , 1990, The American journal of psychiatry.

[14]  T. Fahy,et al.  Some Influences on Regional Variation in Frequency of Prescription of Electroconvulsive Therapy , 1988, British Journal of Psychiatry.

[15]  P Paul-Shaheen,et al.  Small area analysis: a review and analysis of the North American literature. , 1987, Journal of health politics, policy and law.

[16]  J. Freeman,et al.  ARE HOSPITAL SERVICES RATIONED IN NEW HAVEN OR OVER-UTILISED IN BOSTON? , 1987, The Lancet.

[17]  Thompson Jw,et al.  Use of ECT in the United States in 1975 and 1980. , 1987 .

[18]  M. Taylor,et al.  Consumers' views of DSM-III: attitudes and practices of U.S. psychiatrists and 1984 graduating psychiatric residents. , 1986, The American journal of psychiatry.

[19]  R H Brook,et al.  Variations in the use of medical and surgical services by the Medicare population. , 1986, The New England journal of medicine.

[20]  T. Fahy,et al.  Electroconvulsive Therapy in the Republic of Ireland 1982: A Summary of Findings , 1985, British Journal of Psychiatry.

[21]  P. Janicak,et al.  ECT: an assessment of mental health professionals' knowledge and attitudes. , 1985, The Journal of clinical psychiatry.

[22]  J. Griffith,et al.  Clinical profiles of hospital discharge rates in local communities. , 1985, Health services research.

[23]  W. Winslade,et al.  Medical, judicial, and statutory regulation of ECT in the United States. , 1984, The American journal of psychiatry.

[24]  J. Yesavage,et al.  Electroconvulsive therapy in Massachusetts. , 1984, The American journal of psychiatry.

[25]  L. Guttmacher,et al.  Epidemiologic considerations in electroconvulsive therapy. , 1984, Archives of general psychiatry.

[26]  G. Maddala.  Limited-dependent and qualitative variables in econometrics: Introduction , 1983 .

[27]  J. Levenson,et al.  Milieu reactions to ECT. , 1982, Psychiatry.

[28]  N. Roos,et al.  Surgical Rate Variations: Do They Reflect the Health or Socioeconomic Characteristics of the Population? , 1982, Medical care.

[29]  B. Kalayam,et al.  A survey of attitudes on the use of electroconvulsive therapy. , 1981, Hospital & community psychiatry.

[30]  A. Gittelsohn,et al.  Small Area Variations in Health Care Delivery , 1973, Science.

[31]  C. Lewis,et al.  Variations in the incidence of surgery. , 1969, The New England journal of medicine.

[32]  F. Redlich,et al.  Social structure and psychiatric treatment. , 1954, The American journal of orthopsychiatry.

[33]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[34]  M. Fink.  Use of ECT in the United States. , 1988, The American journal of psychiatry.

[35]  B. Barnes,et al.  Professional uncertainty and the problem of supplier-induced demand. , 1982, Social science & medicine.

[36]  M. Fink.  Convulsive therapy : theory and practice , 1979 .