title: Organizational contexts of primary care approaches for managing problem drinking.
abstract: Little is known about the organizational contexts associated with different primary care (PC) approaches to managing PC patients with drinking problems. Relying upon the Chronic Care Model and a theoretically based taxonomy of health care systems, we identified organizational factors distinguishing PC practices using PC-based approaches (managed by PC providers, mental health specialists, or jointly with specialty services) versus referral-based management in the Veterans Affairs health care system. Data were obtained from a national survey of 218 PC practices characterizing usual management approaches as well as practices' leadership, delivery system design, information system, and decision support characteristics and from a national survey of substance use disorder specialty programs. PC- and referral-based practices did not differ on the sufficiency of their structural resources, physician staffing, or on the availability of specialty services. However, PC-based practices were found to take more responsibility for managing patients' chronic conditions and had more staff for decision support activities.
authors.affiliation: Center for Health Care Evaluation, Department of Veterans Affairs, Veterans Affairs Palo Alto Health Care System, Menlo Park Division (MPD-152) 795, Menlo Park, CA 94025, USA. kathleen.schutte@va.gov
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schutte
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Bhagya
authors.initials: B
authors.lastname: Wickrama
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Kirchner
authors.forename: Keith
authors.initials: K
authors.lastname: Humphreys
mesh_terms: D019973:Alcohol-Related Disorders / Q000534:rehabilitation*; D016208:Databases, Factual; D003661:Decision Support Techniques; D006801:Humans; D017146:Models, Organizational; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration