Journal of General Internal Medicine

, Volume 14, Issue 1, pp 39–48

Treating depression in staff-model versus network-model managed care organizations


  • Lisa S. Meredith
    • RAND
  • Lisa V. Rubenstein
    • RAND
    • Center for Healthcare Provider Behavior, Veterans Health AdministrationGreater Los Angeles Health Care System
  • Kathryn Rost
    • University of Arkansas for Medical Sciences
  • Daniel E. Ford
    • Department of MedicineJohns Hopkins Medical Institutions
  • Nancy Gordon
    • Division of ResearchKaiser Permanente Medical Care Program-Northern California
  • Paul Nutting
    • Ambulatory Sentinal Practice Network
  • Patti Camp
    • RAND
  • Kenneth B. Wells
    • RAND
    • Department of Psychiatry and Biobehavioral SciencesUCLA Neuropsychiatric Institute and Hospital, UCLA School of Medicine
Original Articles

DOI: 10.1046/j.1525-1497.1999.00279.x

Cite this article as:
Meredith, L.S., Rubenstein, L.V., Rost, K. et al. J GEN INTERN MED (1999) 14: 39. doi:10.1046/j.1525-1497.1999.00279.x


OBJECTIVE: To compare primary care providers’ depression-related knowledge, attitudes, and practices and to understand how these reports vary for providers in staff or group-model managed care organizations (MCOs) compared with network-model MCOs including independent practice associations and preferred provider organizations.

DESIGN: Survey of primary care providers’ depression-related practices in 1996.

SETTING AND PARTICIPANTS: We surveyed 410 providers, from 80 outpatient clinics, in 11 MCOs participating in four studies designed to improve the quality of depression care in primary care.

MEASUREMENTS AND MAIN RESULTS: We measured knowledge based on depression guidelines, attitudes (beliefs about burden, skill, and barriers) related to depression, and reported behavior. Providers in both types of MCO are equally knowledgeable about treating depression (better knowledge of pharmacologic than psychotherapeutic treatments) and perceive equivalent skills in treating depression. However, compared with network-model providers, staff/group-model providers have stronger beliefs that treating depression is burdensome to their practice. While more staff/group-model providers reported time limitations as a barrier to optimal depression treatment, more network-model providers reported limited access to mental health specialty referral as a barrier. Accordingly, these staff/group-model providers are more likely to treat patients with major depression through referral (51% vs 38%) or to assess but not treat (17% vs 7%), and network-model providers are more likely to prescribe antidepressants (57% vs 6%) as first-line treatment.

CONCLUSIONS: Whereas the providers from staff/group-model MCOs had greater access to and relied more on referral, the providers from network-model organizations were more likely to treat depression themselves. Given varying attitudes and behaviors, improving primary care for the treatment of depression will require unique strategies beyond enhancing technical knowledge for the two types of MCOs.

Key words

depressionknowledgeattitudespracticeprimary caremanaged care

Copyright information

© Society of General Internal Medicine 1999