title: Using Mixed Methods to Examine the Role of Veterans' Illness Perceptions on Depression Treatment Utilization and HEDIS Concordance.
abstract: BACKGROUND
  Although depression screening occurs annually in the Department of Veterans Affairs (VA) primary care, many veterans may not be receiving guideline-concordant depression treatment.
  
  
  OBJECTIVE
  To determine whether veterans' illness perceptions of depression may be serving as barriers to guideline-concordant treatment.
  
  
  METHODS
  We used a prospective, observational design involving a mailed questionnaire and chart review data collection to assess depression treatment utilization and concordance with Healthcare Effectiveness Data and Information Set guidelines adopted by the VA. The Self-Regulation Model of Illness Behavior guided the study.
  
  
  METHODS
  Veterans who screened positive for a new episode of depression at 3 VA primary care clinics in the US northeast.
  
  
  METHODS
  The Illness Perceptions Questionnaire-Revised, measuring patients' perceptions of their symptoms, cause, timeline, consequences, cure or controllability, and coherence of depression and its symptoms, was our primary measure to calculate veterans' illness perceptions. Treatment utilization was assessed 3 months after the positive depression screen through chart review. Healthcare Effectiveness Data and Information Set (HEDIS) guideline-concordant treatment was determined according to a checklist created for the study.
  
  
  RESULTS
  A total of 839 veterans screened positive for a new episode of depression from May 2009-June 2011; 275 (32.8%) completed the survey. Ninety-two (33.9%) received HEDIS guideline-concordant depression treatment. Veterans' illness perceptions of their symptoms, cause, timeline, and controllability of depression predicted receiving guideline-concordant treatment.
  
  
  CONCLUSIONS
  Many veterans are not receiving guideline-concordant treatment for depression. HEDIS guideline measures may not be assessing all aspects of quality depression care. Conversations about veterans' illness perceptions and their specific needs are encouraged to ensure that appropriate treatment is achieved.
authors.affiliation: *Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford †Department of Health Policy and Management, Boston University School of Public Health, Boston ‡Department of Psychiatry, UMass Memorial Medical Center, University Campus, Worcester §Department of Psychiatry, Boston University School of Medicine, VA New England Healthcare System, Bedford, MA ∥Psychology Service, Edith Nourse Rogers Memorial VA Hospital, Bedford ¶General Mental Health Service, VA Boston Healthcare System #Department of Psychiatry, Boston University School of Medicine **Primary Care Service, Providence VA Medical Center, Providence, RI, Boston, MA.
authors.forename: A Rani
authors.initials: AR
authors.lastname: Elwy
authors.forename: Mark E
authors.initials: ME
authors.lastname: Glickman
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Dell
authors.forename: Nora M
authors.initials: NM
authors.lastname: Mueller
authors.forename: Shibei
authors.initials: S
authors.lastname: Zhao
authors.forename: Princess E
authors.initials: PE
authors.lastname: Osei-Bonsu
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rodrigues
authors.forename: Craig M
authors.initials: CM
authors.lastname: Coldwell
authors.forename: Tu A
authors.initials: TA
authors.lastname: Ngo
authors.forename: James
authors.initials: J
authors.lastname: Schlosser
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Vielhauer
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Susan V
authors.initials: SV
authors.lastname: Eisen
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003863:Depression / Q000523:psychology* / Q000628:therapy; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult