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Predictors of primary care management of depression in the Veterans Affairs healthcare system.

Abstract：

BACKGROUND:Primary care providers (PCPs) vary in skills to effectively treat depression. Key features of evidence-based collaborative care models (CCMs) include the availability of depression care managers (DCMs) and mental health specialists (MHSs) in primary care. Little is known, however, about the relationships between PCP characteristics, CCM features, and PCP depression care. OBJECTIVE:To assess relationships between various CCM features, PCP characteristics, and PCP depression management. DESIGN:Cross-sectional analysis of a provider survey. PARTICIPANTS:180 PCPs in eight VA sites nationwide. MAIN MEASURES:Independent variables included scales measuring comfort and difficulty with depression care; collaboration with a MHS; self-reported depression caseload; availability of a collocated MHS, and co-management with a DCM or MHS. Covariates included provider type and gender. For outcomes, we assessed PCP self-reported performance of key depression management behaviors in primary care in the past 6 months. KEY RESULTS:Response rate was 52 % overall, with 47 % attending physicians, 34 % residents, and 19 % nurse practitioners and physician assistants. Half (52 %) reported greater than eight veterans with depression in their panels and a MHS collocated in primary care (50 %). Seven of the eight clinics had a DCM. In multivariable analysis, significant predictors for PCP depression management included comfort, difficulty, co-management with MHSs and numbers of veterans with depression in their panels. CONCLUSIONS:PCPs who felt greater ease and comfort in managing depression, co-managed with MHSs, and reported higher depression caseloads, were more likely to report performing depression management behaviors. Neither a collocated MHS, collaborating with a MHS, nor co-managing with a DCM independently predicted PCP depression management. Because the success of collaborative care for depression depends on the ability and willingness of PCPs to engage in managing depression themselves, along with other providers, more research is necessary to understand how to engage PCPs in depression management.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Chang ET,Magnabosco JL,Chaney E,Lanto A,Simon B,Yano EM,Rubenstein LV

doi

10.1007/s11606-014-2807-z

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

1017-25

issue

eissn

0884-8734

issn

1525-1497

journal_volume

pub_type

杂志文章,多中心研究

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Predictors of primary care management of depression in the Veterans Affairs healthcare system.