Barriers of Quality Care

            There are many barriers of quality care in psychiatric treatment in the primary care setting. Among the barriers include lack of training and education, time constraints, meeting levels of expected productivity, lack of proper treatment paradigm, lack of assessments utilized, and lack of patient compliance.

Lack of Psychiatric Training & Education

One of the biggest problems is the lack of training and education of mental illness in medical school for primary care physicians. There are a limited number of primary care physicians who have been trained to treat mental illnesses. The lack of training and education can result in inappropriate diagnosis, such as underdiagnoses of those with true major depressive disorders and over diagnosis of those who are not. The improper diagnosis inevitably leads to improper treatment of mental health patients.

In a research conducted by Tamburrino, Nagel, & Lynch (2011) results found that 70% of primary care patients do not receive a change of medication or dose within the first 3 months, regardless of their continued or worsening symptoms and complaints of depression. This may indicate that primary care physicians lack adjusting antidepressant medications, which the researchers suggested may attribute to poor rates of recovery and remission of depressive episodes.

Time Constraints

            Time constraints of primary care physicians are indicated as problematic. The time in which a physician has to spend is limited, therefore, it is difficult for proper screening and assessment to be utilized (Clark, 2011). Due to decreasing insurance reimbursement rates, primary care physicians are expected to see more patients in a day. Demands of increasing responsibilities requiring more time outside face-to-face treatment, such as clerical duties and use of electronic medical records also add to time constraints.

Attitudes

            Although the stigma of depression and mental health illnesses have steadily decreased, primary care physicians tend to discredit useful interventions outside their practice (Finley, Rens, & Pont, 2003). Due to the attitudes, they also often poorly distinguish between depression “the disease”, “the symptoms” and “the experience.”

Assessment Utilization

            Studies have found that primary care physicians do not utilize assessments often enough. In the study conducted by Baik, Gonzales, Bowers, Anthony, Tidjani, & Sudman (2010) researchers discovered that primary care clinicians do not routinely use depression instruments for diagnosis and maintenance.  Rather, the study found that the clinicians reported most often using the instruments for aiding the patients in acceptance of their diagnosis of depression (Baik et al, 2010). Furthermore, the study found that the use of depression instruments were reduced for the following reasons: the clinicians’ time was limited, they believed depression lacked objective evidence, and the clinicians where familiar with their patients (Baik et al, 2010).

            Another study by Abed Faghri, Boisvert & Faghri (2010) found 77.5% of their participants reported that they relied on clinical interviewing for diagnoses of psychiatric problems rather than using assessment tools.

Other Barriers

            There are several other barriers of psychiatric care in the primary care setting. The Affordable Care Act (ACA) will provide more opportunities for care of individuals who were not able to access the care previously, however, without changes in education, training, and treatment by primary care physicians, the outcome of treating depressive disorders may remain the same. It is possible that decreasing insurance reimbursement rates will affect the quality of care in that primary care physicians may continue to have less and less time with patients.

Other barriers include lack of treatment paradigm among primary care physicians in treatment of psychiatric illnesses. Although there are treatment paradigms for depressive disorders, primary care physicians are not required to use them, unless the setting requires them to do so. In addition, patient resistance and compliance are also barriers. Many patients who may benefit from psychotherapy resist treatment, therefore family physicians rely on psychotropic treatment alone. In addition, there are compliance issues among some patients, such as taking medications consistently or self-medicating with other substances, such as cocaine or opioids, which may interfere with treatment.