Objectives: To describe how primary care clinicians' perceptions about depression care as a clinical activity changed during the adoption of selective serotonin reuptake inhibitors (SSRIs) in their health maintenance organization (HMO).
Study design: Prospective study of change in primary care clinicians' level of satisfaction from depression care activities from time 1 (mid-1993) to time 2 (early 1995).
Methods: Study subjects were internal medicine and family practice physicians, physician assistants, and nurse practitioners (n = 196) in a large, not-for-profit group-model HMO. We modeled level of satisfaction from depression care activities at time 2 as a function of changes in depression-care-related attitudes and perceptions over the study period, controlling for time 1 level of satisfaction and personal and professional characteristics.
Results: Overall satisfaction showed a small, statistically significant improvement over the study period. Time 2 satisfaction was a function of improved perceptions about the feasibility of primary care treatment of depression, which in turn were related to improved perceptions about the effectiveness of drug treatment. The relevance of clinicians' perceptions about their own depression care skills declined concomitantly.
Conclusions: The adoption of SSRIs in the HMO was associated with improvement in primary care clinicians' perceptions about their ability to successfully treat depression (especially using pharmacology) and in their overall satisfaction from depression care activities. Future research should address whether reliance on SSRIs replaces the use of other depression treatment modalities, and if so, how this reliance affects patient outcomes and satisfaction and overall healthcare costs.