The Role of Pharmaceuticals in Mental Health Care Outcomes

The idea that outcomes associated with the provision of health care are important is not new. In the 1960s Avedis Donabedian (1) presented health outcomes as changes in health status that were attributable to antecedent health care. For many years, however, evaluations of health care focused on the structure or process of care. As health care moves into the new millennium, financing of health care is evolving from individual providers being solely responsible for patient outcomes to an environment where payers, institutions, and providers are being held accountable for quality and cost of care. As financing of health care has moved to a more centralized locus of control, evaluation of outcomes has become more feasible and desirable. In a book titled Who Shall Live, Victor Fuchs (2) discussed three factors that can be balanced in our health care system: costs, quality, and access. Over time the pendulum swings from one to another of these dimensions. If costs containment goes too far, then quality or access may suffer. Likewise, it