title: Treating depression in staff-model versus network-model managed care organizations.
abstract: OBJECTIVE
  To compare primary care providers' depression-related knowledge, attitudes, and practices and to understand how these reports vary for providers in staff or group-model managed care organizations (MCOs) compared with network-model MCOs including independent practice associations and preferred provider organizations.
  
  
  METHODS
  Survey of primary care providers' depression-related practices in 1996.
  
  
  METHODS
  We surveyed 410 providers, from 80 outpatient clinics, in 11 MCOs participating in four studies designed to improve the quality of depression care in primary care.
  
  
  RESULTS
  We measured knowledge based on depression guidelines, attitudes (beliefs about burden, skill, and barriers) related to depression, and reported behavior. Providers in both types of MCO are equally knowledgeable about treating depression (better knowledge of pharmacologic than psychotherapeutic treatments) and perceive equivalent skills in treating depression. However, compared with network-model providers, staff/group-model providers have stronger beliefs that treating depression is burdensome to their practice. While more staff/group-model providers reported time limitations as a barrier to optimal depression treatment, more network-model providers reported limited access to mental health specialty referral as a barrier. Accordingly, these staff/group-model providers are more likely to treat patients with major depression through referral (51% vs 38%) or to assess but not treat (17% vs 7%), and network-model providers are more likely to prescribe antidepressants (57% vs 6%) as first-line treatment.
  
  
  CONCLUSIONS
  Whereas the providers from staff/group-model MCOs had greater access to and relied more on referral, the providers from network-model organizations were more likely to treat depression themselves. Given varying attitudes and behaviors, improving primary care for the treatment of depression will require unique strategies beyond enhancing technical knowledge for the two types of MCOs.
authors.affiliation: RAND, Santa Monica, Calif 90407, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Meredith
authors.forename: L V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: K
authors.initials: K
authors.lastname: Rost
authors.forename: D E
authors.initials: DE
authors.lastname: Ford
authors.forename: N
authors.initials: N
authors.lastname: Gordon
authors.forename: P
authors.initials: P
authors.lastname: Nutting
authors.forename: P
authors.initials: P
authors.lastname: Camp
authors.forename: K B
authors.initials: KB
authors.lastname: Wells
mesh_terms: D016009:Chi-Square Distribution; D003863:Depression / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D017146:Models, Organizational; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires