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. 2002 Feb;17(2):103–111. doi: 10.1046/j.1525-1497.2002.10128.x

Table 3.

Distribution of Barrier Weights Assigned by Physicians for 62 Patients Who Do Not Initiate a Guideline-Concordant Depression Care Plan During the Acute Phase (First 8 Weeks) of Therapy

Clusters and Related Barriers Cluster Weight (% of Total) Barrier Weight
Patient resistance to diagnosis or treatment 2,494.5 (40.2)
 Patient felt other medical condition(s) were a higher priority for treatment 385
 Due to improvement, patient no longer felt need to continue medication 131
 Due to improvement, patient no longer felt need to continue counseling 10
 Patient was satisfied with level of improvement or symptom relief 110
 Patient needed more time to fully accept diagnosis 95
 Patient underestimated the seriousness of the problem, did not understand the need for treatment 480
 Patient disagreed with diagnosis or denied the problem 227.5
 Patient resistant to starting counseling 249
 Patient needed more time to accept treatment with counseling 15
 Patient had concerns or problems regarding medication side effects 80
 Patient resistant to changing dose or type of medication 25
 Patient resistant to starting medication 510
 Patient needed more time to accept treatment with medication 5
 Patient already tried on multiple antidepressant medications 27.5
 Patient frustrated by lack of improvement (“counseling doesn't help”) 45
 Patient frustrated by lack of improvement (“medication does not help”) 100
Patient noncompliance with visits 1,491 (24.0)
 Noncompliance with visits (patient refused to schedule, canceled, or did not show) 1,491
Physician judgment overrides guideline 927 (15.0)
 Physician concerned about adverse effects of antidepressant medication 40
 Physician felt other medical condition(s) were a higher priority for treatment 535
 Physician did not think counseling would be helpful 21
 Physician did not think medication would be helpful 10
 Physician disagreed with diagnosis or results of depression screening (e.g., believed it was a grief reaction, or situational) 155
 Physician found it acceptable for patient to discontinue medication 41
 Physician was satisfied with patient's improvement 125
Patient psychosocial problems and access to care 721 (11.6)
 Patient did not have a phone, could not be reached, or moved 85
 Patient had practical barriers to visits (e.g., transportation, child care, time off work) 39
 Patient could not afford office visits 60
 Patient could not afford medication 28
 Samples of medication no longer available for patient 9
 Patient could not afford counseling 20
 Practical barriers such as time or transportation interfered with counseling 5
 Patient's psychosocial difficulties (e.g., chaotic family environment, stressful life events) distracted patient from depression treatment 475
System barriers 566 (9.1)
 Patient had difficulty accessing counseling providers or appointment 10
 Physician did not refer due to lack of suitable counseling providers 30
 Insurance restrictions were a barrier to counseling 20
 Limited time in visit to address depression 21
 Patient did not have continuity of care, saw different providers in office 75
 Patient's medication managed by mental health specialist outside of your practice 410
   Total assigned weights 6,200 (100)