title: Primary care practice characteristics associated with the quality of care received by patients with depression and comorbid chronic conditions.
abstract: OBJECTIVE
  This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions.
  
  
  METHODS
  Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions.
  
  
  RESULTS
  Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care [odds ratio (OR)=1.61; 95% confidence interval (CI) 1.13-2.30]. Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18-2.65), high value given to teamwork (OR=2.48; 95% CI=1.40-4.38), having at least one general practitioner at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07-2.21) and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30-3.46).
  
  
  CONCLUSIONS
  Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.
authors.affiliation: Department of Social and Preventive Medicine, University of Montreal; Research Centre of the Centre hospitalier de l'Université de Montréal.
authors.forename: Matthew
authors.initials: M
authors.lastname: Menear
authors.affiliation: Faculty of Nursing, University of Montreal.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Duhoux
authors.affiliation: Department of Family Medicine and Emergency Medicine, Sherbrooke University.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Roberge
authors.affiliation: Department of Social and Preventive Medicine, University of Montreal; Research Centre of the Centre hospitalier de l'Université de Montréal. Electronic address: louise.fournier@umontreal.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Fournier
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D011792:Quebec / Q000453:epidemiology; D055815:Young Adult
keywords: Comorbidity; Depression; Organizational factors; Primary care; Quality of health care