title: Predictors of primary care management of depression in the Veterans Affairs healthcare system.
abstract: BACKGROUND
  Primary care providers (PCPs) vary in skills to effectively treat depression. Key features of evidence-based collaborative care models (CCMs) include the availability of depression care managers (DCMs) and mental health specialists (MHSs) in primary care. Little is known, however, about the relationships between PCP characteristics, CCM features, and PCP depression care.
  
  
  OBJECTIVE
  To assess relationships between various CCM features, PCP characteristics, and PCP depression management.
  
  
  METHODS
  Cross-sectional analysis of a provider survey.
  
  
  METHODS
  180 PCPs in eight VA sites nationwide.
  
  
  METHODS
  Independent variables included scales measuring comfort and difficulty with depression care; collaboration with a MHS; self-reported depression caseload; availability of a collocated MHS, and co-management with a DCM or MHS. Covariates included provider type and gender. For outcomes, we assessed PCP self-reported performance of key depression management behaviors in primary care in the past 6 months.
  
  
  RESULTS
  Response rate was 52 % overall, with 47 % attending physicians, 34 % residents, and 19 % nurse practitioners and physician assistants. Half (52 %) reported greater than eight veterans with depression in their panels and a MHS collocated in primary care (50 %). Seven of the eight clinics had a DCM. In multivariable analysis, significant predictors for PCP depression management included comfort, difficulty, co-management with MHSs and numbers of veterans with depression in their panels.
  
  
  CONCLUSIONS
  PCPs who felt greater ease and comfort in managing depression, co-managed with MHSs, and reported higher depression caseloads, were more likely to report performing depression management behaviors. Neither a collocated MHS, collaborating with a MHS, nor co-managing with a DCM independently predicted PCP depression management. Because the success of collaborative care for depression depends on the ability and willingness of PCPs to engage in managing depression themselves, along with other providers, more research is necessary to understand how to engage PCPs in depression management.
authors.affiliation: Department of General Internal Medicine, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA, Evelyn.chang@va.gov.
authors.forename: Evelyn T
authors.initials: ET
authors.lastname: Chang
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Magnabosco
authors.forename: Edmund
authors.initials: E
authors.lastname: Chaney
authors.forename: Andrew
authors.initials: A
authors.lastname: Lanto
authors.forename: Barbara
authors.initials: B
authors.lastname: Simon
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*