Understanding ''Usual'' Interpersonal Care for Depression

Role of Clinician Specialty and Payment System

by Lisa S. Meredith, Kenneth B. Wells, Sherrie Kaplan, Rebecca Mazel

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Studies support the efficacy of manualized psychotherapy for depression, but little is known about interpersonal care in typical outpatient practice. The authors propose and test a framework for evaluating interpersonal care for depression and contrast clinicians (N = 470) by specialty and patients' predominant payment system. Compared with general medical clinicians, psychologists and psychiatrists had higher perceptions of skill and spent more time counseling for psychosocial problems, perceived more benefit from treating depression, were more inclined to personally treat depression, were more likely to share decisionmaking control, and communicated more sensitivity to their patients. General medical clinicians counseled more aggressively, reported better skill concerning general health promotion, and were more cost-conscious. Clinicians treating mostly prepaid rather the fee-for-service patients spent less time counseling and were less inclined to personally treat depression, but were more inclined to share control. Findings illustrate the value of the framework and provide new information about variation in such care.

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