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Predictors of Primary Care Management of Depression in the Veterans Affairs Healthcare System

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ABSTRACT

BACKGROUND

Primary care providers (PCPs) vary in skills to effectively treat depression. Key features of evidence-based 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 care.

OBJECTIVE

To assess relationships between various CCM features, PCP characteristics, and PCP depression management.

DESIGN

Cross-sectional analysis of a provider survey.

PARTICIPANTS

180 PCPs in eight VA sites nationwide.

MAIN MEASURES

Independent variables included scales measuring comfort and difficulty with depression care; collaboration with a MHS; self-reported depression caseload; availability of a collocated MHS, and co-management with a DCM or MHS. Covariates included provider type and gender. For outcomes, we assessed PCP self-reported performance of key depression management behaviors in primary care in the past 6 months.

KEY RESULTS

Response 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, co-management with MHSs and numbers of veterans with depression in their panels.

CONCLUSIONS

PCPs who felt greater ease and comfort in managing depression, co-managed 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 co-managing 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 management.

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Acknowledgements

Contributors 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 manuscript.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, or the US government, or other affiliated institutions.

Funders

The ReTIDES project “Expanding and Testing VA Collaborative Care Models for Depression” was supported by VA HSR&D (Project #MNT 03-215, 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 65-020). Dr. Yano’s time was funded by the VA HSR&D Service through a Senior Research Career Scientist Award (Project # RCS 05-195).

Conflicts of Interest

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

Author information

Authors and Affiliations

  1. Department of General Internal Medicine, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Evelyn T. Chang MD, MSHS & Lisa V. Rubenstein MD, MSPH

  2. VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA

    Evelyn T. Chang MD, MSHS, Andrew Lanto MA, Barbara Simon MA, Elizabeth M. Yano PhD, MSPH & Lisa V. Rubenstein MD, MSPH

  3. Center for Implementation Practice & Research Support, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA

    Jennifer L. Magnabosco PhD & Lisa V. Rubenstein MD, MSPH

  4. Yo San University of Traditional Chinese Medicine, Los Angeles, CA, USA

    Jennifer L. Magnabosco PhD

  5. University of Washington Psychiatry and Behavioral Sciences Department, Seattle, WA, USA

    Edmund Chaney PhD

  6. Health Services Research & Development Northwest Center of Excellence, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA

    Edmund Chaney PhD

  7. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano PhD, MSPH & Lisa V. Rubenstein MD, MSPH

  8. Department of Medicine, UCLA School of Medicine, Los Angeles, CA, USA

    Lisa V. Rubenstein MD, MSPH

  9. RAND Corporation, Santa Monica, CA, USA

    Lisa V. Rubenstein MD, MSPH

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  1. Evelyn T. Chang MD, MSHS
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  2. Jennifer L. Magnabosco PhD
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  6. Elizabeth M. Yano PhD, MSPH
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  7. Lisa V. Rubenstein MD, MSPH
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Correspondence to Evelyn T. Chang MD, MSHS.

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Chang, E.T., Magnabosco, J.L., Chaney, E. et al. Predictors of Primary Care Management of Depression in the Veterans Affairs Healthcare System. J GEN INTERN MED 29, 1017–1025 (2014). https://doi.org/10.1007/s11606-014-2807-z

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  • DOI: https://doi.org/10.1007/s11606-014-2807-z

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