Treatment and follow-up of anxiety and depression in clinical-scenario patients: survey of Saskatchewan family physicians.

OBJECTIVE To explore family physicians' recommendations for treatment of, and number of weeks to first follow-up visit for, clinical-scenario patients presenting with symptoms of either a major depressive episode (MDE) or generalized anxiety disorder (GAD), as well as physicians' perceived barriers to optimal care for these patients. DESIGN Cross-sectional survey. SETTING Saskatchewan. PARTICIPANTS A total of 331 family physicians practising in Saskatchewan as of December 2007. MAIN OUTCOME MEASURES Type of treatment and number of weeks to first follow-up visit recommended for clinical-scenario patients, as well as family physicians' barriers to providing optimal care. RESULTS The response rate was 49.7% (331 of 666 surveys returned). Most physicians recommended treatment of the GAD-scenario patient (93.7%) and the MDE-scenario patient (90.1%). Most physicians recommended immediate (65.6%) rather than delayed (28.1%) treatment of the GAD-scenario patient, and immediate (55.6%) rather than delayed (34.5%) treatment of the MDE-scenario patient. Pharmacotherapy alone (26.3%) was the most commonly recommended immediate treatment of the GAD-scenario patient; combination pharmacotherapy and counseling (15.8%) was the most commonly recommended immediate treatment of the MDE-scenario patient. Most physicians recommended that the first follow-up visit occur within 2 weeks for the GAD (79.4%) and the MDE (82.5%) clinical-scenario patients. Physicians were more likely to identify themselves rather than patients and the health care system as barriers to providing optimal care to the GAD (39.4%) and the MDE (39.8%) clinical-scenario patients. CONCLUSION Most family physicians recommend immediate treatment and early follow-up for patients presenting with symptoms of GAD or MDE. Physician-related barriers outweigh patient and health system barriers to providing optimal care to patients with common psychiatric disorders.