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Health Serv Res. 1998 October; 33(4 Pt 1): 891–910.
PMCID: PMC1070292

Too little time? The recognition and treatment of mental health problems in primary care.

Abstract

OBJECTIVES: To assess the effect of practice characteristics on the diagnosis and treatment of mental health problems in primary care. DATA SOURCE: National Ambulatory Medical Care Survey (NAMCS) 1991-1994. STUDY DESIGN: We examine the effect of visit characteristics and practice characteristics on rates of diagnosis of mental health problems, rates of referral, and rates of use of psychotropic medications. We characterize each primary care physician's practice using information about the ways in which that physician treated patients who did not have mental health problems. PRINCIPAL FINDINGS: We find that median visit duration has a small, statistically insignificant effect on the rate of diagnosis and treatment of mental health problems. Physicians with large HMO caseloads are slightly more likely to diagnose mental health problems, but less likely to prescribe psychotropic medications, than are physicians who see few HMO patients. Practice style and specialty are important determinants of diagnosis and, to a lesser extent, of treatment. CONCLUSIONS: Physicians specialty and practice style are more strongly related to mental health diagnosis and treatment than are system characteristics such as visit duration and insurance composition.

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Selected References

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  • Badger LW, deGruy FV, Hartman J, Plant MA, Leeper J, Ficken R, Maxwell A, Rand E, Anderson R, Templeton B. Psychosocial interest, medical interviews, and the recognition of depression. Arch Fam Med. 1994 Oct;3(10):899–907. [PubMed]
  • Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry. 1988 Dec;45(12):1100–1106. [PubMed]
  • Eisenberg L. Treating depression and anxiety in primary care. Closing the gap between knowledge and practice. N Engl J Med. 1992 Apr 16;326(16):1080–1084. [PubMed]
  • Goldberg DP, Jenkins L, Millar T, Faragher EB. The ability of trainee general practitioners to identify psychological distress among their patients. Psychol Med. 1993 Feb;23(1):185–193. [PubMed]
  • Goldsmith JC, Goran MJ. Managed care mythology: supply-side dreams die hard. Healthc Forum J. 1996 Nov-Dec;39(6):42–47. [PubMed]
  • Kroenke K. Discovering depression in medical patients: reasonable expectations. Ann Intern Med. 1997 Mar 15;126(6):463–465. [PubMed]
  • Leaf PJ, Bruce ML, Tischler GL, Freeman DH, Jr, Weissman MM, Myers JK. Factors affecting the utilization of specialty and general medical mental health services. Med Care. 1988 Jan;26(1):9–26. [PubMed]
  • Leaf PJ, Livingston MM, Tischler GL, Weissman MM, Holzer CE, 3rd, Myers JK. Contact with health professionals for the treatment of psychiatric and emotional problems. Med Care. 1985 Dec;23(12):1322–1337. [PubMed]
  • Lemelin J, Hotz S, Swensen R, Elmslie T. Depression in primary care. Why do we miss the diagnosis? Can Fam Physician. 1994 Jan;40:104–108. [PMC free article] [PubMed]
  • Main DS, Lutz LJ, Barrett JE, Matthew J, Miller RS. The role of primary care clinician attitudes, beliefs, and training in the diagnosis and treatment of depression. A report from the Ambulatory Sentinel Practice Network Inc. Arch Fam Med. 1993 Oct;2(10):1061–1066. [PubMed]
  • Marks JN, Goldberg DP, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979 May;9(2):337–353. [PubMed]
  • Mechanic D. Treating mental illness: generalist versus specialist. Health Aff (Millwood) 1990 Winter;9(4):61–75. [PubMed]
  • Rogers WH, Wells KB, Meredith LS, Sturm R, Burnam MA. Outcomes for adult outpatients with depression under prepaid or fee-for-service financing. Arch Gen Psychiatry. 1993 Jul;50(7):517–525. [PubMed]
  • Shapiro S, German PS, Skinner EA, VonKorff M, Turner RW, Klein LE, Teitelbaum ML, Kramer M, Burke JD, Jr, Burns BJ. An experiment to change detection and management of mental morbidity in primary care. Med Care. 1987 Apr;25(4):327–339. [PubMed]
  • Tarlov AR, Ware JE, Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA. 1989 Aug 18;262(7):925–930. [PubMed]
  • Wells KB, Manning WG, Jr, Valdez RB. The effects of a prepaid group practice on mental health outcomes. Health Serv Res. 1990 Oct;25(4):615–625. [PMC free article] [PubMed]

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