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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3080 — Barriers to Psychological & Behavioral Intervention in Primary Care

Mohr DC (CMC3, Hines VA)

Objectives:
Two-thirds of depressed primary care patients say they would prefer psychological or behavioral care to pharmacotherapy. However, only 20% follow-up on referrals and half of those drop out of treatment. While recent evidence suggests that barriers to psychological and behavioral intervention (e.g. time constraints, transportation problems, etc.) may account for a substantial amount of the discrepancy between stated preferences and actual follow-up with care, no good method of measuring such barriers exists. We have developed the Barriers to Behavioral Care (BBC) questionnaire and are piloting it in two settings.

Methods:
Study 1: 600 patients from the Northwestern University (NU) General Internal Medicine clinic will complete the BBC by November 1st. Study 2: The BBC is also being administered to veterans in three VA CBOCs as part of an HSR&D trial of a telemental health intervention; 50 veterans are expected to complete the measure by 1/31/08.

Results:
Study 1: Currently 350 NU patients have completed the measure. Preliminary results show that the BBC has an overall Cronbach’s alpha=.95, with 5 factors (Stigma, alpha=.93; Negative views of counseling, alpha=.93; Transportation problems and medical symptoms, alpha=.89; Finding and paying for services alpha=.85; Caregiving responsibilities, alpha=.72) accounting for 81% of the variance. Depression significantly increases BBC scores (ps < .05). Study 2: These analyses will be repeated on the full sample of 600 NU patients and cross validated on the VA CBOC veterans.

Implications:
This is the first comprehensive measure of barriers to psychological and behavioral care. Initial results suggest that depression is not only an indicator for psychotherapy, but may also be a barrier to receiving it.

Impacts:
This report provides data on a new assessment tool. Understanding barriers to psychotherapy and behavioral care is critical to develop strategies to overcome those barriers.


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