ABSTRACT
BACKGROUND
Practice system tools improve chronic disease care, but are generally lacking for the care of depression in most primary care settings.
OBJECTIVE
To describe the frequency of various depression-related practice system tools among Minnesota primary care clinics interested in improving depression care.
DESIGN
Cross-sectional survey.
PARTICIPANTS
Physician leaders of 82 clinics in Minnesota.
MAIN MEASURES
A survey including practice systems recommended for care of depression and chronic conditions, each scored on a 100-point scale, and the clinic’s priority for improving depression care on a 10-point scale.
KEY RESULTS
Fewer practice systems tools were present and functioning well for depression care (score = 24.4 [SD 1.6]) than for the care of chronic conditions in general (score = 43.9 [SD 1.6]), p < 0.001. The average priority for improving depression care was 5.8 (SD 2.3). There was not a significant correlation between the presence of practice systems for depression or chronic disease care and the priority for depression care except for a modest correlation with the depression Decision Support subscale (r = 0.29, p = 0.008). Certain staffing patterns, a metropolitan-area clinic location, and the presence of a fully functional electronic medical record were associated with the presence of more practice system tools.
CONCLUSIONS
Few practice system tools are in place for improving depression care in Minnesota primary care clinics, and these are less well-developed than general chronic disease practice systems. Future research should focus on demonstrating whether implementing these tools for depression care results in much-needed improvements in care for patients with depression.
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Acknowledgements
This research would not have been possible without the active support of payer organizations (Blue Cross and Blue Shield of Minnesota, First Plan, HealthPartners, Medica, Minnesota Dept. of Human Services, Preferred One, and U Care) who helped identify potential study subjects, as well as the medical group and clinic leaders who provided physician information, completed surveys, and cooperated with evaluation of patients reporting suicidal thoughts. Those medical groups include Allina Medical Clinic, Aspen Medical Group, CentraCare, Community-University Health Care Center, Fairview Health Services, Family Health Services Minnesota, Family Practice Medical Center, Grand Itasca Clinic, HealthPartners Medical Group, Mankato Clinic, Mayo Clinic, Montevideo Hospital and Clinic, Northwest Family Physicians, Olmsted Medical Center, Park Nicollet Clinics, Paynesville Area Health Care System, Quello Clinic, Ridgeview Medical Center, River Falls Medical Clinic, St. Mary’s/Duluth Clinic Health System, Stillwater Medical Group, Superior Health Medical Group, and University of Minnesota Physicians.
We also are very grateful for the collaboration with the Institute for Clinical Systems Improvement in coordinating the needs of the Initiative and the Study, especially Nancy Jaeckels and Gary Oftedahl. Patient subject recruitment and surveys have been managed over three years by Colleen King and her wonderful staff at the HealthPartners Research Foundation Data Collection Center.
Conflict of Interest
None disclosed.
Funding support
This research was funded by grant #5R01MH080692 from the National Institute of Mental Health.
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Margolis, K.L., Solberg, L.I., Crain, A.L. et al. Prevalence of Practice System Tools for Improving Depression Care Among Primary Care Clinics: The DIAMOND Initiative. J GEN INTERN MED 26, 999–1004 (2011). https://doi.org/10.1007/s11606-011-1739-0
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DOI: https://doi.org/10.1007/s11606-011-1739-0