Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Coyne suggests that free medication
and psychotherapy compromised the value of our intervention. In fact, our
intervention addressed numerous barriers to adequate treatment, including
both physician factors (eg, knowledge, competing demands) and patient factors
(eg, denial, stigma, adverse effects). We also demonstrated the acceptability
and effectiveness of using care managers to promote evidence-based treatment
for in primary care. A next step is to increase patients' access to such care
by reducing barriers affecting providers (eg, reimbursement) and practices
(eg, organization, space).
Bruce ML, Alexopoulos GS, Schulberg HC, Ten Have T, Katz IR, Reynolds III CF. Interventions for Treatment of Depression in Primary Care—Reply. JAMA. 2004;291(23):2814. doi:10.1001/jama.291.23.2815-b