Physician management preferences and barriers to care for rural patients with depression

To describe rural primary care physicians' current preferences in treating depression and the barriers they face in providing effective care for this condition.

Cross-sectional survey of randomly selected practicing primary care physicians registered in Arkansas.

Primary care practices in nonmetropolitan counties.

Forty of 50 eligible physicians completed a face-to-face interview; one physician, an interview by telephone; and two physicians, an interview in questionnaire form. Total response rate was 86%.

Physician preferences for and barriers to the effective management of depression.

An estimated 44% of rural physicians consider medication alone to be the best initial approach to treating depression; 30% prefer to prescribe medication and refer patients to mental health care professionals for counseling; and 26% prefer to prescribe medication and conduct counseling themselves. The greatest barriers to treatment were the physician's lack of time and the patient's failure to recognize depression. Most physicians had recently referred one or more depressed patients to specialty care and had encountered few referral sources, long waiting lists, and inadequate follow-up.

The majority of rural primary care physicians prefer to treat depressed patients in their practices themselves. Except for the limited availability of specialty services, most of the barriers to the provision of effective care for depression perceived by rural physicians do not appear to be unique to rural practices.