Primary care physicians' approach to depressive disorders effects of physician specialty and practice structure

John W. Williams, Kathryn Rost, Allen J. Dietrich, Mary C. Ciotti, Stephen J. Zyzanski, John Cornell

Research output: Contribution to journalArticle

234 Citations (Scopus)

Abstract

Background: Because primary care physicians (PCPs) are the initial health care contact for most patients with depression, they are in a unique position to provide early detection and integrated care for persons with depression and coexisting medical illness. Despite this opportunity, care for depression is often suboptimal. Objective: To better understand how to design interventions to improve care, we examine PCPs' approach to recognition and management and the effects of physician specialty and degree of capitation on barriers to care for 3 common depressive disorders. Methods: A 53-item questionnaire was mailed to 3375 randomly selected subjects, divided equally among family physicians, general internists, and obstetriciangynecologists. The questionnaire assessed reported diagnosis and treatment practices for each subject's most recent patient recognized to have major or minor depression or dysthymia and barriers to the recognition and treatment of depression. Eligible physicians were PCPs who worked at least half-time seeing outpatients for longitudinal care. Results: Of 2316 physicians with known eligibility, 1350 (58.3%) returned the questionnaire. Respondents were family physicians (n = 621), general internists (n = 474), and obstetrician-gynecologists (n = 255). The PCPs report recognition and evaluation practices related to their most recent case as follows: recognition by routine ques-tioning or screening for depression (9%), diagnosis based on formal criteria (33.7%), direct questioning about suicide (58%), and assessment for substance abuse (68.1%) or medical causes of depression (84.1%). Reported treatment practices were watchful waiting only (6.1%), PCP counseling for more than 5 minutes (39.7%), antidepressant medication prescription (72.5%), and mental health referral (38.4%). Diagnostic evaluation and treatment approaches varied significantly by specialty but not by the type of depression or degree of capitation. Physician barriers differed by specialty more than by degree of capitation. In contrast, organizational barriers, such as time for an adequate history and the affordability of mental health professionals, differed by degree of capitation more than by physician specialty. Patient barriers were common but did not vary by physician specialty or degree of capitation. Conclusions: A substantial proportion of PCPs report diagnostic and treatment approaches that are consistent with high-quality care. Differences in approach were associated more with specialty than with type of depressive disorder or degree of capitation. Quality improvement efforts need to (1) be tailored for different physician specialties, (2) emphasize the importance of differentiating major depression from other depressive disorders and tailoring the treatment approach accordingly, and (3) address organizational barriers to best practice and knowledge gaps about depression treatment.

Original languageEnglish (US)
Pages (from-to)58-67
Number of pages10
JournalArchives of Family Medicine
Volume8
Issue number1
StatePublished - 1999

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Primary Care Physicians
Depressive Disorder
Depression
Physicians
Family Physicians
Therapeutics
Mental Health
Watchful Waiting
Quality of Health Care
Ambulatory Care
Quality Improvement
Practice Guidelines
Suicide
Antidepressive Agents
Substance-Related Disorders
Prescriptions
Counseling
Referral and Consultation
History
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Williams, J. W., Rost, K., Dietrich, A. J., Ciotti, M. C., Zyzanski, S. J., & Cornell, J. (1999). Primary care physicians' approach to depressive disorders effects of physician specialty and practice structure. Archives of Family Medicine, 8(1), 58-67.

Primary care physicians' approach to depressive disorders effects of physician specialty and practice structure. / Williams, John W.; Rost, Kathryn; Dietrich, Allen J.; Ciotti, Mary C.; Zyzanski, Stephen J.; Cornell, John.

In: Archives of Family Medicine, Vol. 8, No. 1, 1999, p. 58-67.

Research output: Contribution to journalArticle

Williams, JW, Rost, K, Dietrich, AJ, Ciotti, MC, Zyzanski, SJ & Cornell, J 1999, 'Primary care physicians' approach to depressive disorders effects of physician specialty and practice structure', Archives of Family Medicine, vol. 8, no. 1, pp. 58-67.
Williams, John W. ; Rost, Kathryn ; Dietrich, Allen J. ; Ciotti, Mary C. ; Zyzanski, Stephen J. ; Cornell, John. / Primary care physicians' approach to depressive disorders effects of physician specialty and practice structure. In: Archives of Family Medicine. 1999 ; Vol. 8, No. 1. pp. 58-67.
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