3012 — Customizing VA Depression Care Approaches in Response to Veterans' Needs and Preferences: A Novel Approach

Campbell DG, University of Montana; Simon BF, VA GLA; Simon A, VA GLA; Lombardero A, University of Montana; Bolkan CR, Washington State University; Bonner LM, VA Puget Sound GRECC; Zivin K, VA Ann Arbor; Waltz TJ, Eastern Michigan University; Chaney EF, VA Puget Sound; Rubenstein LV, VA GLA
Davis, T

Objectives:
An intensive longitudinal HSRandD/QUERI project examined VA depression care in a representative sample of Veterans with major depression visiting nine primary care practices across three VISNs. The project resulted in nine publications or works-in-progress addressing patient characteristics, needs, preferences and outcomes. Moving these findings into practice was difficult, in part, because results were isolated from the concerns and perspectives of VA operations implementation personnel. We used key stakeholder expert panel (EP) methods to synthesize results across studies into recommendations for patient-centered depression care. We describe the EP process and results and their implications for improving implementation and outcomes of Primary Care-Mental Health (PCMH) integrated care.

Methods:
We reviewed products from the Well-being Among Veterans Enhancement Study (WAVES) to identify key clinical focus areas and generate specific recommendations for care within them. We then assembled an EP of stakeholders with diverse VA responsibilities and expertise/interest in depression care. Panelists rated specific recommendations' importance and feasibility; an online EP discussion of these ratings resulted in a revised confirmatory survey.

Results:
WAVES review identified eight focus areas: employment, family involvement, stigma, illness complexity, treatment preferences, spiritual counseling, and women's and minority needs. We generated 50 recommendations across areas. The EP rated addressing Veterans' preferences for PCMH care providers and treatment options as the most important implementation focus area. All other areas received high importance ratings. Panelists endorsed 17 detailed implications regarding strategies to use for specific recommendations. EP comments also identified 25 anticipated implementation barriers for specific strategies.

Implications:
This project demonstrated a novel method's effectiveness for translating research findings into actionable clinical strategies. Results identify depression care improvement priorities and facilitate translating findings into staff activities in the PACT environment.

Impacts:
We systematically focused tacit and explicit knowledge of clinical, research and administrative VA leaders on data regarding depressed Veterans. This approach may enhance the salience of research-based findings for managers and policymakers.