Dataset Information

Prevalence of practice system tools for improving depression care among primary care clinics: the DIAMOND initiative.

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.

SUBMITTER: Margolis KL

PROVIDER: S-EPMC3157530 | biostudies-literature | 2011 Sep

REPOSITORIES: biostudies-literature

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Publications

Prevalence of practice system tools for improving depression care among primary care clinics: the DIAMOND initiative.

Margolis Karen L KL Solberg Leif I LI Crain A Lauren AL Whitebird Robin R RR Ohnsorg Kristin A KA Jaeckels Nancy N Oftedahl Gary G Glasgow Russell E RE

Journal of general internal medicine 20110520 9

<h4>Background</h4>Practice system tools improve chronic disease care, but are generally lacking for the care of depression in most primary care settings.<h4>Objective</h4>To describe the frequency of various depression-related practice system tools among Minnesota primary care clinics interested in improving depression care.<h4>Design</h4>Cross-sectional survey.<h4>Participants</h4>Physician leaders of 82 clinics in Minnesota.<h4>Main measures</h4>A survey including practice systems recommended ...[more]

PMID: 21598053

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Project description:BACKGROUND:By law, the provision of medical treatment to minors in the State of Israel is conditional upon the consent of their parents. In 2004, the Head of the Medical Administration Unit in the Ministry of Health issued Circular No. 4/2004 regarding the treatment of un-accompanied minors in primary care clinics. This circular aims to expand on the law, and permits the treatment of certain minors without parental attendance or consent. The circular does indicate that parents should be notified of the treatment retroactively, and provides cases in which it is possible to avoid notification altogether. The objectives of this study were: (a) to examine the scope of treatment of unaccompanied minors in primary care clinics; (b) to examine caregivers' knowledge of the provisions of the law and of the circular; and (c) to examine the implementation of the law's and the circular's provisions relating to the treatment of unaccompanied minors in primary care clinics in the community. METHODS:In a cross-sectional study, we surveyed 158 doctors and nurses from primary care clinics of the Haifa and Galilee districts of "Clalit Health Services". Respondents were selected via a snowball method, with attention to ensuring a heterogeneous clientele and geographic dispersion. RESULTS:Treatment seeking by unaccompanied minors is an existing and even widespread phenomenon. The vast majority of unaccompanied minors were in effect treated without parental consent. The main reason for minors' solitary treatment seeking was parents being busy. In 40% of the cases, where minors were treated without the presence and consent of their parents - parents were not notified of the fact. None of the respondents correctly answered all questions regarding the relevant provisions of the law and circular, and only 10% answered all the questions regarding the circular's parental notification requirements. CONCLUSIONS:The Israeli legal arrangement, pertaining to the provision of treatment to minors without the consent of their parents, is vague, unclear to medical and nursing practitioners and limited in terms of the needs of the minors themselves, as well as the needs of the medical system. There is a need for methodical and coherent regulatory thinking on the subject, as well as more thorough education of both nurses and physicians, in order to ensure the rights and interests of minors as well as the rights of their parents.

Project description:BackgroundDepression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered.ObjectiveThis article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions.DesignGrounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data.ParticipantsSeventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners.Key resultsA depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression.ConclusionsThe clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

Dataset Information

Prevalence of practice system tools for improving depression care among primary care clinics: the DIAMOND initiative.

Background

Objective

Design

Participants

Main measures

Key results

Conclusions

Publications

Prevalence of practice system tools for improving depression care among primary care clinics: the DIAMOND initiative.

Similar Datasets

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