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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3080 — Barriers to Psychological & Behavioral Intervention in Primary Care

Mohr DC (CMC3, Hines VA)

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.

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.

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.

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.

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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