Journal of General Internal Medicine

, Volume 33, Issue 8, pp 1366–1373 | Cite as

The Role of Primary Care Experiences in Obtaining Treatment for Depression

  • Audrey L. Jones
  • Maria K. Mor
  • Gretchen L. Haas
  • Adam J. Gordon
  • John P. Cashy
  • James H. Schaefer Jr
  • Leslie R. M. Hausmann
Original Research



Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown.


In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression.

Design and Participants

We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration’s national 2013 PCMH Survey of Healthcare Experiences of Patients.

Main Measures

We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1.

Key Results

Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2.


In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients’ subsequent initiation and continuation of depression treatment over time—a relationship that could affect physical and mental health outcomes.


patient-centered care depression primary care veterans 



Dr. Jones is supported as a VA Office of Academic Affiliations Associated Health Professions Post-Doctoral Fellow in Medical Informatics (TMI 95-660) at the Informatics, Decision-Enhancement and Analytic Sciences Center (#150HX001240) at the VA Salt Lake City Health Care System.

Results from this study were presented as a poster at the 2016 American Public Health Association Annual Meeting in Denver, CO, and the 2017 VA Health Services Research and Development and Quality Enhancement Research Initiative National Meeting in Crystal Springs, VA.

Funding Information

The work reported here was supported by the Department of Veterans Affairs VISN4 CHERP Competitive Research Pilot Program (LIP 72-081).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government.

Supplementary material

11606_2018_4522_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)


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Copyright information

© Society of General Internal Medicine (This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply) 2018

Authors and Affiliations

  • Audrey L. Jones
    • 1
    • 2
  • Maria K. Mor
    • 3
    • 4
  • Gretchen L. Haas
    • 5
    • 6
  • Adam J. Gordon
    • 1
    • 2
  • John P. Cashy
    • 3
  • James H. Schaefer Jr
    • 7
  • Leslie R. M. Hausmann
    • 3
    • 8
  1. 1.Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0)Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUSA
  2. 2.Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUSA
  3. 3.Center for Health Equity Research and Promotion (CHERP)VA Pittsburgh Healthcare SystemPittsburghUSA
  4. 4.Department of BiostatisticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  5. 5.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  6. 6.VISN4 Mental Illness Research, Education, and Clinical CenterVeterans Affairs Pittsburgh Healthcare SystemPittsburghUSA
  7. 7.Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and DeploymentDurhamUSA
  8. 8.Division of General Internal Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA

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