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Open Access Research article

Organizational factors and depression management in community-based primary care settings

Edward P Post123*, Amy M Kilbourne234, Robert W Bremer5, Francis X Solano6, Harold Alan Pincus78 and Charles F Reynolds109

Author Affiliations

1 Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

2 National VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA

3 Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA

4 Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA

5 Department of Psychiatry, University of Colorado Medical School, Denver, Colorado, USA

6 Community Medicine Inc and Center for Quality Improvement and Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

7 RAND-University of Pittsburgh Health Institute, Pittsburgh, Pennsylvania, USA

8 Department of Psychiatry, Columbia University, New York, New York, USA

9 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

10 Departments of Neurology and Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

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Implementation Science 2009, 4:84  doi:10.1186/1748-5908-4-84

Published: 31 December 2009

Abstract

Background

Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework.

Methods

We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance).

Results

The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment.

Conclusions

The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.