Predictors of Primary Care Management of Depressio

Authors: Evelyn T Chang Jennifer L Magnabosco Edmund Chaney Andrew Lanto Barbara Simon Elizabeth M Yano Lisa V Rubenstein

Publish Date: 2014/02/25

Volume: 29, Issue: 7, Pages: 1017-1025

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Abstract

Primary care providers PCPs vary in skills to effectively treat depression Key features of evidencebased 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 careIndependent variables included scales measuring comfort and difficulty with depression care collaboration with a MHS selfreported depression caseload availability of a collocated MHS and comanagement with a DCM or MHS Covariates included provider type and gender For outcomes we assessed PCP selfreported performance of key depression management behaviors in primary care in the past 6 monthsResponse 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 comanagement with MHSs and numbers of veterans with depression in their panelsPCPs who felt greater ease and comfort in managing depression comanaged 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 comanaging 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 managementContributors include Michelle Seelig MD MSHS Jeff Spina MD in survey development and Martin Lee PhD and Michael Mitchell PhD for statistical consultation We would like to thank Jack Needleman PhD for reviewing earlier drafts of this manuscriptThe ReTIDES project “Expanding and Testing VA Collaborative Care Models for Depression” was supported by VA HSRD Project MNT 03215 PIs Lisa Rubenstein MD MSHS and Edmund Chaney PhD and VA Mental Health Quality Enhancement Research Initiative Funding support for preparation of this paper was provided by VA Office of Academic Affiliations through the Health Services Research Fellowship Training Program TMP 65020 Dr Yano’s time was funded by the VA HSRD Service through a Senior Research Career Scientist Award Project RCS 05195

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