Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression.
OBJECTIVE
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.
Meredith
Lisa S
LS
RAND Corporation, 1776 Main St., Santa Monica, CA 90407-2138, USA.
Cheng
Wendy J Y
WJ
Hickey
Scot C
SC
Dwight-Johnson
Megan
M
D000328:Adult; D001294:Attitude to Health; D002755:Choice Behavior; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D019370:Observation; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014481:United States