Physician management preferences and barriers to care for rural patients with depression
K. Rost, J. Humphrey and K. Kelleher
National Institute of Mental Health Center for Rural Mental Healthcare Research, Little Rock.
OBJECTIVE: To describe rural primary care physicians' current preferences
in treating depression and the barriers they face in providing effective
care for this condition. DESIGN: Cross-sectional survey of randomly
selected practicing primary care physicians registered in Arkansas.
SETTING: Primary care practices in nonmetropolitan counties. PARTICIPANTS:
Forty of 50 eligible physicians completed a face-to-face interview; one
physician, an interview by telephone; and two physicians, an interview in
questionnaire form. Total response rate was 86%. MAIN OUTCOME MEASURES:
Physician preferences for and barriers to the effective management of
depression. RESULTS: An estimated 44% of rural physicians consider
medication alone to be the best initial approach to treating depression;
30% prefer to prescribe medication and refer patients to mental health care
professionals for counseling; and 26% prefer to prescribe medication and
conduct counseling themselves. The greatest barriers to treatment were the
physician's lack of time and the patient's failure to recognize depression.
Most physicians had recently referred one or more depressed patients to
specialty care and had encountered few referral sources, long waiting
lists, and inadequate follow-up. CONCLUSIONS: The majority of rural primary
care physicians prefer to treat depressed patients in their practices
themselves. Except for the limited availability of specialty services, most
of the barriers to the provision of effective care for depression perceived
by rural physicians do not appear to be unique to rural practices.
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