title: A survey of primary care provider attitudes and behaviors regarding treatment of adult depression: what changes after a collaborative care intervention?
abstract: OBJECTIVE
  To assess primary care provider (PCP) attitudes and self-reported behavior with regard to identifying and managing depression in adult patients before and after a chronic disease/collaborative care intervention.
  
  
  METHODS
  A self-administered cross-sectional survey was conducted in 6 targeted practices among 39 family practice physicians, family nurse practitioners, and residents before and after implementation of a depression in primary care project. In this project, the sites received tools and training in depression screening and guideline-concordant treatment, facilitated referral services for patients to access mental health providers, psychiatric phone consultation, patient education materials, and services of a depression care manager. The project was conducted from June 2003 through June 2006.
  
  
  RESULTS
  Comparison of responses prior to and after the intervention showed that significantly or nearly significantly larger proportions of PCPs endorsed the importance of depression as a patient presenting problem (p = .000), increased provision of supportive counseling (p = .13), more often identified counseling or therapy as effective (p = .07), and more often referred patients to mental health services (p = .001). PCPs also reduced their perception that treating depression is time consuming (p = .000).
  
  
  CONCLUSIONS
  After a chronic disease/collaborative care approach to depression treatment in primary care was implemented, PCP attitudes and behaviors about depression treatment were significantly modified. More guideline-concordant care, and increased collaboration with mental health services, was reported. Implications for future primary care depression intervention activities and research are discussed.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA. carole.upshur@umassmed.edu
authors.forename: Carole
authors.initials: C
authors.lastname: Upshur
authors.forename: Linda
authors.initials: L
authors.lastname: Weinreb