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	Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 8 No. 1, January 1999   Archives  •  Online Features Original Contribution  This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (136)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Primary Care/ Family Medicine  • Psychiatry  • Depression  • Alert me on articles by topic Primary Care Physicians' Approach to Depressive Disorders Effects of Physician Specialty and Practice Structure John W. Williams, Jr, MD, MHS; Kathryn Rost, PhD; Allen J. Dietrich, MD; Mary C. Ciotti, MD; Stephen J. Zyzanski, PhD; John Cornell, PhD Arch Fam Med. 1999;8:58-67. 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 obstetrician-gynecologists. 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 questioning 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. From the Audie Murphy Division, South Texas Veterans Health Care System, and the Division of General Internal Medicine, University of Texas Health Science Center–San Antonio (Drs Williams and Cornell); the University of Arkansas School of Medicine and the Little Rock Health Services Research and Development Field Program, Little Rock (Dr Rost); the Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH (Dr Dietrich); the Department of Obstetrics and Gynecology, Michigan State University School of Medicine, Lansing (Dr Ciotti); and the Department of Family Medicine and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio (Dr Zyzanski). RELATED ARTICLE The Archives of Family Medicine Continuing Medical Education Program Arch Fam Med. 1999;8(1):23-25. FULL TEXT   THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Adapted Behavior Therapy for Persistently Depressed Primary Care Patients: An Open Trial Uebelacker et al. Behav Modif 2009;33:374-395. 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