Clinician- and Organization-Level Factors in the Adoption of Evidence-Based Care for Depression in Primary Care

Published In: Health Care Management Review, v. 33, no. 4, Oct.-Dec. 2008, p. 289-299

Posted on RAND.org on January 01, 2008

by Rachel M. Henke, Thomas McGuire, Alan M. Zaslavsky, Daniel Ford, Lisa S. Meredith, Jose J. Arbelaez

Read More

Access further information on this document at Lippincott Williams and Wilkins

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND AND PURPOSE: Although more individuals are receiving care for depression than those in the past, they often do not receive high-quality care. Strategies to improve quality have focused on changing clinician behavior and more recently on reducing practice barriers. Both strategies hold promise but have had widely varying success either because practices have not successfully removed barriers or because removing barriers alone is not sufficient for improving care. It is unknown under which circumstances clinicians with a high propensity toward recognizing depression and providing depression care can overcome barriers. The authors explore organizational and clinician factors affecting patient receipt of guideline-concordant services. METHODOLOGY/APPROACH: The authors use data from adult patients with major depression receiving care in a geographically diverse group of primary care practices participating in the Quality Improvement for Depression study. The authors estimate the effects of barriers and clinician propensity on six aspects of depression care and adequate treatment. FINDINGS: Barriers and propensity interact in affecting depression services. In comparison with similar clinicians in practices with few barriers, high-propensity clinicians working in practices with more barriers are less likely to provide depression education and are likely to provide fewer follow-up calls and fewer follow-up visits. High-propensity clinicians are more likely to offer antidepressants in practices with more barriers. PRACTICE IMPLICATIONS: To improve the quality of care, efforts should both eliminate practice barriers and increase clinician propensity to provide care. Future research on factors associated with quality improvement can benefit from an approach which specifies how organizational and clinician factors interact to enact change.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.