Study Examines Determinants of Implementing Depression Care Improvement Models in VA Primary Care Practices
Methods for improving depression care in primary care settings have been studied and shown to be effective and cost-effective; however, the uptake of evidence-based models for improving depression care for primary care patients has been slow. This study examined three VA-endorsed depression care models and tested the relationships between theoretically-based measures of organizational readiness and implementation of the models in VA primary care clinics. The three models include: 1) collocation of mental health specialists in primary care settings, 2) the Translating Initiatives in Depression (TIDES) model, and 3) the Behavioral Health Laboratory (BHL) model. Investigators used a qualitative assessment of these three models and a nationwide cross-sectional survey of primary care clinic directors to measure the organizational readiness of 225 VA primary care practices in relationship to which depression care improvement model the practices chose to adopt. The survey was conducted in 2007.
Findings show that pre-existing demographic and readiness characteristics of primary care practices are associated with whether the practice chooses to implement a depression care improvement model — and with what type of model the practice chooses among alternatives. Of the three approaches, primary care practices appear most ready to implement collocation, which had been present the longest (average 6 years) in practices adopting it. Moreover, the majority of practices that had not adopted it planned to do so. By 2007, 107 (48%) clinics had implemented collocation, 39 (17%) had implemented TIDES, and 17 (8%) had implemented BHL. Having established quality improvement processes or a depression clinician champion was associated with collocation. Being located in a VA regional network that endorsed TIDES was associated with TIDES implementation. The presence of psychologists or psychiatrists on primary care staff, greater financial sufficiency, or greater space sufficiency was associated with BHL implementation.
Chang E, Rose D, Yano E, Wells K, Metzger M, Post E, Lee M, and Rubenstein L. Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Healthcare System. Journal of General Internal Medicine October 5, 2012;e-pub ahead of print.
This study was funded by HSR&D (IIR 09-082), and Dr. Yano was supported by an HSR&D Research Career Scientist Award (RCS 05-195). Drs. Rose, Yano, Lee, and Rubenstein are part of HSR&D Center for the Study of Healthcare Provider Behavior, Sepulveda, CA. Dr. Rubenstein is also Director of HSR&D Center for Implementation Practice and Research Support, also located in Sepulveda.