Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.
Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.



Manitoba Health undertook a primary care renewal initiative in 2006 called the PIN, which included the development of mental health indicators specific to screening and managing follow-up for depression. These indicators were implemented in three PIN group practice sites in Manitoba, which are also part of Shared Mental Health Care.



The design was a non-experimental longitudinal design. A formative evaluation investigated the implementation and initial impact of the mental health indicators using mixed methods (document review, survey, and interview). Quantitative data was explored using descriptive and comparative statistics and a content and theme analysis of the qualitative interviews was conducted. Survey responses were received from 32 out of 36 physicians from the three sites. Interviews were conducted with 15 providers. Findings This evaluation illustrated providers' perceived attitudes, knowledge, skills, and behaviours related to recognizing and treating depression and expanded our understanding of primary care processes related to managing depression related to the implementation of a new initiative. Depression is viewed as an important problem in primary care practice that is time consuming to diagnose, manage and treat and requires further investigation. Implementation of the PIN mental health indicators was variable across sites and providers. There was an increase in use of the indicators across time and a general sentiment that benefits of screening outweigh the costs; however, the benefit of screening for depression remains unclear. Consistent with current guidelines, a question the findings of this evaluation suggests is whether there are more effective ways of having an impact on depression within primary care than screening.
1Department of Clinical Health Psychology, Faculty of Medicine,University of Manitoba & Shared Mental Health Care,Winnipeg Regional Health Authority,Winnipeg MB R3E 3N4,Canada.
Julie
J
Beaulac
2Special advisor to the Deputy Minister on Primary Care,Manitoba Health,Winnipeg MB R3B 3M9,Canada.
Jeanette
J
Edwards
3Physician Integrated Network,Manitoba Health,Winnipeg MB R3B 3M9,Canada.
Angus
A
Steele
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration / Q000639:trends; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D006305:Health Status Indicators; D006801:Humans; D007400:Interprofessional Relations; D008137:Longitudinal Studies; D008350:Manitoba; D008403:Mass Screening / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration / Q000639:trends; D015397:Program Evaluation
collaborative care; depression screening; primary care reform