The Role of Primary Care Experiences in Obtaining Treatment for Depression
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.
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.
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.
KEY WORDSpatient-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.
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.
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