title: Veterans with depression in primary care: provider preferences, matching, and care satisfaction.
abstract: Primary care is often the first point of care for individuals with depression. Depressed patients often have comorbid alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). Understanding variations in treatment preferences and care satisfaction in this population can improve care planning and outcomes. The design involved a cross-sectional comparison of veterans screening positive for depression. Veterans receiving primary care during the previous year were contacted (n = 10, 929) and were screened for depression using the PHQ-2/PHQ-9. Those with probable depression (n = 761) underwent a comprehensive assessment including screens for AUD and PTSD, treatment provider preferences, treatments received, and satisfaction with care. Treatment provider preferences differed based on specific mental health comorbidities, and satisfaction with care was associated with receipt of preferred care. Depressed veterans with comorbid PTSD were more likely to prefer care from more than one provider type (e.g., a psychiatrist and a primary care provider) and were more likely to receive treatment that matched their preferences than veterans without comorbid PTSD. Veterans receiving full or partial treatment matches affirmed satisfaction with care at higher rates, and veterans with comorbid PTSD were least satisfied when care did not match their preferences. Patient satisfaction with care is an increasingly important focus for health care systems. This study found significant variations in depressed patients' satisfaction with care in terms of treatment matching, particularly among those with comorbid PTSD. Delivery of care that matches patient treatment preferences is likely to improve depressed patient's satisfaction with the care provided. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
authors.affiliation: Department of Psychology, Eastern Michigan University.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Waltz
authors.affiliation: Department of Psychology, University of Montana.
authors.forename: Duncan G
authors.initials: DG
authors.lastname: Campbell
authors.affiliation: Arkansas Department of Veterans Affairs, Mental Health QUERI, HSR&D.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Kirchner
authors.affiliation: Department of Psychology, University of Montana.
authors.forename: Anayansi
authors.initials: A
authors.lastname: Lombardero
authors.affiliation: Department of Human Development, Washington State University Vancouver.
authors.forename: Cory
authors.initials: C
authors.lastname: Bolkan
authors.affiliation: Veterans Affairs Ann Arbor, Center for Clinical Management Research (CCMR), HSR&D.
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.affiliation: Veterans Affairs Greater Los Angeles, HSR&D.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lanto
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Chaney
authors.affiliation: Veterans Affairs Greater Los Angeles, HSR&D Center for Implementation Practice and Research Support.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
mesh_terms: D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D057240:Patient Preference; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States; D058014:Veterans Health