PMID- 23054917
OWN - NLM
STAT- MEDLINE
DCOM- 20130822
LR  - 20231106
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 28
IP  - 3
DP  - 2013 Mar
TI  - Determinants of readiness for primary care-mental health integration (PC-MHI) in 
      the VA Health Care System.
PG  - 353-62
LID - 10.1007/s11606-012-2217-z [doi]
AB  - BACKGROUND: Depression management can be challenging for primary care (PC) 
      settings. While several evidence-based models exist for depression care, little 
      is known about the relationships between PC practice characteristics, model 
      characteristics, and the practice's choices regarding model adoption. OBJECTIVE: 
      We examined three Veterans Affairs (VA)-endorsed depression care models and 
      tested the relationships between theoretically-anchored measures of 
      organizational readiness and implementation of the models in VA PC clinics. 
      DESIGN: 1) Qualitative assessment of the three VA-endorsed depression care 
      models, 2) Cross-sectional survey of leaders from 225 VA medium-to-large PC 
      practices, both in 2007. MAIN MEASURES: We assessed PC readiness factors related 
      to resource adequacy, motivation for change, staff attributes, and organizational 
      climate. As outcomes, we measured implementation of one of the VA-endorsed 
      models: collocation, Translating Initiatives in Depression into Effective 
      Solutions (TIDES), and Behavioral Health Lab (BHL). We performed bivariate and, 
      when possible, multivariate analyses of readiness factors for each model. KEY 
      RESULTS: Collocation is a relatively simple arrangement with a mental health 
      specialist physically located in PC. TIDES and BHL are more complex; they use 
      standardized assessments and care management based on evidence-based 
      collaborative care principles, but with different organizational requirements. By 
      2007, 107 (47.5 %) clinics had implemented collocation, 39 (17.3 %) TIDES, and 17 
      (7.6 %) BHL. Having established quality improvement processes (OR 2.30, [1.36, 
      3.87], p = 0.002) or a depression clinician champion (OR 2.36, [1.14, 4.88], 
      p = 0.02) was associated with collocation. Being located in a VA regional network 
      that endorsed TIDES (OR 8.42, [3.69, 19.26], p < 0.001) was associated with TIDES 
      implementation. The presence of psychologists or psychiatrists on PC staff, 
      greater financial sufficiency, or greater spatial sufficiency was associated with 
      BHL implementation. CONCLUSIONS: Both readiness factors and characteristics of 
      depression care models influence model adoption. Greater model simplicity may 
      make collocation attractive within local quality improvement efforts. 
      Dissemination through regional networks may be effective for more complex models 
      such as TIDES.
FAU - Chang, Evelyn T
AU  - Chang ET
AD  - VA Greater Los Angeles, General Internal Medicine, Los Angeles, CA, USA. 
      evelyn.chang@va.gov
FAU - Rose, Danielle E
AU  - Rose DE
FAU - Yano, Elizabeth M
AU  - Yano EM
FAU - Wells, Kenneth B
AU  - Wells KB
FAU - Metzger, Maureen E
AU  - Metzger ME
FAU - Post, Edward P
AU  - Post EP
FAU - Lee, Martin L
AU  - Lee ML
FAU - Rubenstein, Lisa V
AU  - Rubenstein LV
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20121005
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
SB  - IM
CIN - J Gen Intern Med. 2013 Mar;28(3):333-5. PMID: 23138760
MH  - Cross-Sectional Studies
MH  - Delivery of Health Care, Integrated/*organization & administration
MH  - Depression/*therapy
MH  - Health Care Reform/methods
MH  - Humans
MH  - Mental Health Services/*organization & administration
MH  - Models, Organizational
MH  - Motivation
MH  - Primary Health Care/*organization & administration
MH  - Qualitative Research
MH  - Quality Improvement/organization & administration
MH  - United States
MH  - Veterans Health
PMC - PMC3579970
EDAT- 2012/10/12 06:00
MHDA- 2013/08/24 06:00
PMCR- 2014/03/01
CRDT- 2012/10/12 06:00
PHST- 2012/02/28 00:00 [received]
PHST- 2012/08/13 00:00 [accepted]
PHST- 2012/07/26 00:00 [revised]
PHST- 2012/10/12 06:00 [entrez]
PHST- 2012/10/12 06:00 [pubmed]
PHST- 2013/08/24 06:00 [medline]
PHST- 2014/03/01 00:00 [pmc-release]
AID - 2217 [pii]
AID - 10.1007/s11606-012-2217-z [doi]
PST - ppublish
SO  - J Gen Intern Med. 2013 Mar;28(3):353-62. doi: 10.1007/s11606-012-2217-z. Epub 
      2012 Oct 5.