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) |