OBJECTIVES: Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who present with less severe depression. This study examined factors associated with primary care clinicians' choice of a watchful waiting approach to care management for depression. METHODS: Secondary data were analyzed from Partners in Care, which examined dissemination of best practices for depression in primary care. Primary care clinicians' decisions regarding watchful waiting were examined by using the baseline survey data from Partners in Care completed by clinicians and patients from February 1996 to March 1997. Participants were 167 primary care clinicians from 46 practices of seven managed care organizations across the United States and their 1,187 patients with depression. Primary care clinicians' proclivity for watchful waiting was examined by using a brief scenario describing a patient with major depressive disorder. RESULTS: Thirty-four clinicians (20 percent) reported a strong proclivity to use watchful waiting for the patient in the scenario. The proclivity was significantly associated with clinicians' reports of the proportion of their actual patients with whom they used this approach. Clinicians were significantly more likely to choose watchful waiting for their actual patients if they had more psychotherapy knowledge (p=.035) or perceived that the need to treat the patient's medical illness was more important than the need to treat his or her mental illness (p=.046) and were less likely to choose a watchful waiting approach if they perceived the lack of availability of mental health professionals as a barrier (p=.050). CONCLUSIONS: Primary care clinicians' knowledge of treatment and perception of barriers influence their proclivity for watchful waiting. Clinician education to promote appropriate use of watchful waiting on the basis of clinical need is recommended.
OBJECTIVES: Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who present with less severe depression. This study examined factors associated with primary care clinicians' choice of a watchful waiting approach to care management for depression. METHODS: Secondary data were analyzed from Partners in Care, which examined dissemination of best practices for depression in primary care. Primary care clinicians' decisions regarding watchful waiting were examined by using the baseline survey data from Partners in Care completed by clinicians and patients from February 1996 to March 1997. Participants were 167 primary care clinicians from 46 practices of seven managed care organizations across the United States and their 1,187 patients with depression. Primary care clinicians' proclivity for watchful waiting was examined by using a brief scenario describing a patient with major depressive disorder. RESULTS: Thirty-four clinicians (20 percent) reported a strong proclivity to use watchful waiting for the patient in the scenario. The proclivity was significantly associated with clinicians' reports of the proportion of their actual patients with whom they used this approach. Clinicians were significantly more likely to choose watchful waiting for their actual patients if they had more psychotherapy knowledge (p=.035) or perceived that the need to treat the patient's medical illness was more important than the need to treat his or her mental illness (p=.046) and were less likely to choose a watchful waiting approach if they perceived the lack of availability of mental health professionals as a barrier (p=.050). CONCLUSIONS: Primary care clinicians' knowledge of treatment and perception of barriers influence their proclivity for watchful waiting. Clinician education to promote appropriate use of watchful waiting on the basis of clinical need is recommended.
Authors: Maria Rubio-Valera; María Teresa Peñarrubia-María; Maria Iglesias-González; Martin Knapp; Paul McCrone; Marta Roig; Ramón Sabes-Figuera; Juan V Luciano; Juan M Mendive; Ana Gabriela Murrugara-Centurión; Jordi Alonso; Antoni Serrano-Blanco Journal: Eur J Health Econ Date: 2019-02-06
Authors: Jeanne Miranda; Michael K Ong; Loretta Jones; Bowen Chung; Elizabeth L Dixon; Lingqi Tang; Jim Gilmore; Cathy Sherbourne; Victoria K Ngo; Susan Stockdale; Esmeralda Ramos; Thomas R Belin; Kenneth B Wells Journal: J Gen Intern Med Date: 2013-05-14 Impact factor: 5.128
Authors: Maria Rubio-Valera; Imma Beneitez; María Teresa Peñarrubia-María; Juan V Luciano; Juan M Mendive; Paul McCrone; Martin Knapp; Ramon Sabés-Figuera; Katarzyna Kocyan; Javier García-Campayo; Antoni Serrano-Blanco Journal: BMC Psychiatry Date: 2015-03-31 Impact factor: 3.630