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)