Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3026 — Facility and Provider-Level Determinants of Depression Screening Adherence

Author List:
Flanagan ME (Roudebush VA Medical Center)
Doebbeling BN (Roudebush VA Medical Center)

Objectives:
A critical element of any implementation process is for the end-user to be committed, motivated, and able to easily follow clinical practice guidelines (CPGs). The extent to which an implementation is successful is influenced by the degree to which users feel the adoption will result in positive outcomes (improved care), understand the change (knowledge), and hold positive attitudes toward the change mechanism (i.e., CPGs). Individual provider CPG adherence is one way to gauge progress in implementing CPGs. The purpose of this study is to identify facility and provider-level factors that influence adherence to depression screening measures.

Methods:
We conducted a national survey of primary care VA physicians, physician assistants, nurses, and nurse practitioners (N=2438) selected from all VAMCs regarding four CPGs, including major depressive disorder (MDD). All item responses were scored on a 5-point Likert scale. The dependent measure reflected the proportion of primary care patients the respondent routinely screened for depression. Generalized estimating equation (GEE) models tested the relationship between number of facility-level MDD implementation strategies (0-14), attitudes toward CPGs (7-items), and knowledge of the MDD CPG in particular (6-items) with adherence. The analysis controlled for provider gender, provider age, and provider occupation.

Results:
Facility-level (number of MDD CPG implementation strategies) and provider-level factors (attitudes toward CPGs, MDD CPG specific knowledge) influenced depression screening adherence. Specifically, provider attitudes moderated both relationships between number of MDD CPG implementation strategies (p=0.08) and knowledge of the MDD CPG (p=0.02) with depression screening adherence. For both interactions, those with more negative attitudes toward CPGs in general reported higher levels of screening when they had greater knowledge of the MDD CPG, or were in facilities with more MDD guideline implementation strategies.

Implications:
Even for those providers with relatively negative attitudes toward CPGs, depression screening adherence is higher when the facility uses a greater number of implementation strategies or when the provider is more knowledgeable about the MDD CPG dimensions.

Impacts:
Implementation-process factors and provider attitudes and knowledge all facilitate depression screening. These results emphasize the importance of the implementation process in enhancing adherence to preventive measures such as MDD screening.