Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4061 — Positive Experiences with Primary Care Predict Receipt of Guideline-Concordant Treatment for Depression

Lead/Presenter: Audrey Jones, COIN - Salt Lake City
All Authors: Jones AL (VA Salt Lake City Health Care System) Mor MK (VA Pittsburgh Healthcare System) Haas GL (VA Pittsburgh Health Care System) Gordon AJ (VA Salt Lake City Health Care System) Cashy JP (VA Pittsburgh Healthcare System) Schaefer JH (VA Office of Analytics and Business Intelligence) Hausmann LR (VA Pittsburgh Healthcare System)

Objectives:
Despite clinical guidelines for administering effective antidepressant and psychotherapy treatments, only half of Veterans with depression receive guideline-concordant treatment. The relationship between primary care experiences and receipt of guideline-concordant treatment for depression is unknown. We examined whether primary care experiences differed based on Veterans' prior receipt of guideline-concordant depression treatment, and whether positive versus negative healthcare experiences predicted Veterans' subsequent initiation or continuation of guideline-concordant treatment.

Methods:
We conducted a lagged cross-sectional study of guideline-concordant depression treatment in the year prior (Y1) and year following (Y2) completion of the Veterans Health Administration (VHA)'s 2013 Survey of Healthcare Experiences of Patients (SHEP) among respondents with depression diagnoses (n = 27,362). Patient experiences were assessed in 8 domains (each categorized as positive/moderate/negative). Guideline-concordant treatment, determined from VHA administrative records, was defined as 90 days antidepressant or 6 psychotherapy visits. Multinomial regressions estimated differences in Y1 patient experiences for patients who did versus did not receive guideline-concordant treatment in Y1. Logistic regressions then measured associations between Y1 SHEP experiences and Y2 receipt of guideline-concordant treatment.

Results:
Compared to participants who did not receive guideline-concordant treatment in Y1 (n = 4,613), Veterans receiving guideline-concordant treatment (n = 22,749) reported more positive experiences in 3 primary care domains (provider communication, care coordination, medication decision-making), but fewer positive experiences in 1 domain (comprehensiveness). Among those who did not receive guideline-concordant treatment in Y1, positive primary care experiences in 4 domains (communication, comprehensiveness, medication decision-making, self-management support) predicted greater initiation of guideline-concordant treatment in Y2. Among those who did receive guideline-concordant treatment in Y1, positive or moderate experiences in 6 domains (communication, provider rating, comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of guideline-concordant treatment in Y2.

Implications:
Domains of primary care relevant to integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support are important predictors of patients' initiation and continuation of depression treatment over time--a relationship which could affect physical and mental health outcomes.

Impacts:
Attending to the healthcare experiences of depressed persons may improve participation in guideline-concordant depression treatment.