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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

Abstract

Background

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.

Objective

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.

Conclusions

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.

KEY WORDS

patient-centered care depression primary care veterans 

Notes

Acknowledgments

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.

Disclaimer

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)

References

  1. 1.
    Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). J Am Board Fam Med. 2003;289(23):3095–3105.Google Scholar
  2. 2.
    Gonzalez HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW. Depression care in the United States: too little for too few. Arch Gen Psychiatry. 2010;67(1):37–46.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58(1):55–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Hepner KA, Rowe M, Rost K, et al. The effect of adherence to practice guidelines on depression outcomes. Ann Intern Med. 2007;147(5):320–329.CrossRefPubMedGoogle Scholar
  5. 5.
    Watkins KE, Paddock SM, Hudson TJ, et al. Association between quality measures and mortality in individuals with co-occurring mental health and substance use disorders. J Subst Abuse Treat. 2016;69:1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Campbell DG, Bonner LM, Bolkan CR, et al. Stigma predicts treatment preferences and care engagement among Veterans Affairs primary care patients with depression. Ann Behav Med. 2016;50(4):533–544.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Fortney JC, Harman JS, Xu S, Dong F. The association between rural residence and the use, type, and quality of depression care. J Rural Health. 2010;26(3):205–213.CrossRefPubMedGoogle Scholar
  8. 8.
    Teh CF, Sorbero MJ, Mihalyo MJ, et al. Predictors of adequate depression treatment among medicaid-enrolled adults. Health Serv Res. 2010;45(1):302–315.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Duhoux A, Fournier L, Gauvin L, Roberge P. Quality of care for major depression and its determinants: a multilevel analysis. BMC Psychiatry. 2012;12:142.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    True G, Rigg KK, Butler A. Understanding barriers to mental health care for recent war veterans through photovoice. Qual Health Res. 2015;25(10):1443–1455.CrossRefPubMedGoogle Scholar
  11. 11.
    Spoont M, Nelson D, van Ryn M, Alegria M. Racial and ethnic variation in perceptions of VA mental health providers are associated with treatment retention among veterans with PTSD. Med Care. 2017;55(Suppl 9 Suppl 2):S33-S42.CrossRefPubMedGoogle Scholar
  12. 12.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):629–640.CrossRefPubMedGoogle Scholar
  13. 13.
    Petterson S, Miller BF, Payne-Murphy JC, Phillips RL. Mental health treatment in the primary care setting: patterns and pathways. Fam Syst Health. 2014;32(2):157–166.CrossRefPubMedGoogle Scholar
  14. 14.
    Carcaise-Edinboro P, Bradley CJ. Influence of patient-provider communication on colorectal cancer screening. Med Care. 2008;46(7):738–745.CrossRefPubMedGoogle Scholar
  15. 15.
    Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172(5):405–411.CrossRefPubMedGoogle Scholar
  16. 16.
    Gary TL, Maiese EM, Batts-Turner M, Wang NY, Brancati FL. Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes. Dis Manag. 2005;8(6):361–371.CrossRefPubMedGoogle Scholar
  17. 17.
    Liu Y, Malin JL, Diamant AL, Thind A, Maly RC. Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat. 2013;137(3):829–836.CrossRefPubMedGoogle Scholar
  18. 18.
    Ratanawongsa N, Karter AJ, Parker MM, et al. Communication and medication refill adherence: the diabetes study of Northern California. JAMA Intern Med. 2013;173(3):210–218.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47(3):213–220.PubMedGoogle Scholar
  20. 20.
    Sequist TD, Schneider EC, Anastario M, et al. Quality monitoring of physicians: linking patients’ experiences of care to clinical quality and outcomes. J Gen Intern Med. 2008;23(11):1784–1790.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bauer AM, Parker MM, Schillinger D, et al. Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (DISTANCE). J Gen Intern Med. 2014;29(8):1139–1147.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Clever SL, Ford DE, Rubenstein LV, et al. Primary care patients’ involvement in decision-making is associated with improvement in depression. Med Care. 2006;44(5):398–405.CrossRefPubMedGoogle Scholar
  23. 23.
    Rossom RC, Solberg LI, Vazquez-Benitez G, et al. The effects of patient-centered depression care on patient satisfaction and depression remission. Fam Pract. 2016;33(6):649–655.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Johnston BJ. The role of patient experience and its influence on adherence to antidepressant treatment. J Psychosoc Nurs Ment Health Serv. 2013;51(12):29–37.CrossRefPubMedGoogle Scholar
  25. 25.
    Kaplan JE, Keeley RD, Engel M, Emsermann C, Brody D. Aspects of patient and clinician language predict adherence to antidepressant medication. J Am Board Fam Med. 2013;26(4):409–420.CrossRefPubMedGoogle Scholar
  26. 26.
    Loh A, Leonhart R, Wills CE, Simon D, Harter M. The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns. 2007;65(1):69–78.CrossRefPubMedGoogle Scholar
  27. 27.
    Nelson KM, Helfrich C, Sun H, et al. Implementation of the patient-centered medical home in the veterans health administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med. 2014;174(8):1350–1358.CrossRefPubMedGoogle Scholar
  28. 28.
    Werner RM, Canamucio A, Shea JA, True G. The medical home transformation in the veterans health administration: an evaluation of early changes in primary care delivery. Health Serv Res. 2014;49(4):1329–47.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Szymanski BR, Bohnert KM, Zivin K, McCarthy JF. Integrated care: treatment initiation following positive depression screens. J Gen Intern Med. 2013;28(3):346–352.CrossRefPubMedGoogle Scholar
  30. 30.
    Yano EM, Chaney EF, Campbell DG, et al. Yield of practice-based depression screening in VA primary care settings. J Gen Intern Med. 2012;27(3):331–338.CrossRefPubMedGoogle Scholar
  31. 31.
    Zivin K, Pfeiffer PN, Szymanski BR, et al. Initiation of primary care-mental health integration programs in the va health system: associations with psychiatric diagnoses in primary care. Med Care. 2010;48(9):843–851.CrossRefPubMedGoogle Scholar
  32. 32.
    VHA Office of Analytics and Business Intelligence. The shep patient centered medical home (PCMH) survey technical specifications. Washington DC: Department of Veterans Affairs; 2012: http://vaww.car.rtp.med.va.gov/programs/shep/shep.aspx. Accessed 01 May 2018.
  33. 33.
    Frayne SM, Miller DR, Sharkansky EJ, et al. Using administrative data to identify mental illness: what approach is best? Am J Med Qual. 2010;25(1):42–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Hays RD, Berman LJ, Kanter MH, et al. Evaluating the psychometric properties of the CAHPS patient-centered medical home survey. Clin Ther. 2014;36(5):689–696 e681.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Scholle SH, Vuong O, Ding L, et al. Development of and field test results for the CAHPS PCMH survey. Med Care. 2012;50(Suppl):S2–10.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Jones AL, Mor MK, Cashy JP, et al. Racial/ethnic differences in primary care experiences in patient-centered medical homes among veterans with mental health and substance use disorders. J Gen Intern Med. 2016;31(12):1435–1443.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Department of Veterans Affairs, Department of Defense. VA/DoD clinical practice guidelilines for the management of major depressive disorder. 2009.Google Scholar
  38. 38.
    Hahm HC, Cook BL, Ault-Brutus A, Alegria M. Intersection of race-ethnicity and gender in depression care: screening, access, and minimally adequate treatment. Psychiatr Serv. 2015;66(3):258–264.CrossRefPubMedGoogle Scholar
  39. 39.
    Watkins KE, Smith B, Akincigil A, et al. The quality of medication treatment for mental disorders in the department of veterans affairs and in private-sector plans. Psychiatr Serv. 2016;67(4):391–396.CrossRefPubMedGoogle Scholar
  40. 40.
    Burnett-Zeigler I, Zivin K, Ilgen MA, Islam K, Bohnert AS. Perceptions of quality of health care among veterans with psychiatric disorders. Psychiatr Serv. 2011;62(9):1054–1059.CrossRefPubMedGoogle Scholar
  41. 41.
    Hausmann LR, Gao S, Mor MK, Schaefer JH Jr., Fine MJ. Understanding racial and ethnic differences in patient experiences with outpatient health care in Veterans Affairs Medical Centers. Med Care. 2013;51(6):532–539.CrossRefPubMedGoogle Scholar
  42. 42.
    Fasoli DR, Glickman ME, Eisen SV. Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services. Med Care. 2010;48(4):288–295.CrossRefPubMedGoogle Scholar
  43. 43.
    Quinones AR, Thielke SM, Beaver KA, Trivedi RB, Williams EC, Fan VS. Racial and ethnic differences in receipt of antidepressants and psychotherapy by veterans with chronic depression. Psychiatr Serv. 2014;65(2):193–200.CrossRefPubMedGoogle Scholar
  44. 44.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–619.CrossRefPubMedGoogle Scholar
  45. 45.
    Wray LO, Szymanski BR, Kearney LK, McCarthy JF. Implementation of primary care-mental health integration services in the veterans health administration: program activity and associations with engagement in specialty mental health services. J Clin Psychol Med Settings. 2012;19(1):105–116.CrossRefPubMedGoogle Scholar
  46. 46.
    Stata [computer program]. Version 13. College Station: StataCorp LP; 2013.Google Scholar
  47. 47.
    Bultman DC, Svarstad BL. Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Educ Couns. 2000;40(2):173–185.CrossRefPubMedGoogle Scholar
  48. 48.
    Butow P, Sharpe L. The impact of communication on adherence in pain management. Pain 2013;154(Suppl 1):S101–107.CrossRefPubMedGoogle Scholar
  49. 49.
    Sleath B, Rubin RH, Huston SA. Hispanic ethnicity, physician-patient communication, and antidepressant adherence. Compr Psychiatry. 2003;44(3):198–204.CrossRefPubMedGoogle Scholar
  50. 50.
    Martino SC, Elliott MN, Haviland AM, Saliba D, Burkhart Q, Kanouse DE. Comparing the health care experiences of medicare beneficiaries with and without depressive symptoms in medicare managed care versus fee-for-service. Health Serv Res. 2016;51(3):1002–1020.CrossRefPubMedGoogle Scholar
  51. 51.
    Pfeiffer PN, Szymanski BR, Valenstein M, McCarthy JF, Zivin K. Trends in antidepressant prescribing for new episodes of depression and implications for health system quality measures. Med Care. 2012;50(1):86–90.CrossRefPubMedGoogle Scholar
  52. 52.
    Kimerling R, Pavao J, Wong A. Patient activation and mental health care experiences among women veterans. Admin Pol Ment Health. 2016;43(4):506–513.CrossRefGoogle Scholar

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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