Treating Depression in Staff-Model Versus Network-Model Managed Care Organizations
Article first published online: 25 DEC 2001
1999 by the Society of General Internal Medicine
Journal of General Internal Medicine
Volume 14, Issue 1, pages 39–48, January 1999
How to Cite
Meredith, L. S., Rubenstein, L. V., Rost, K., Ford, D. E., Gordon, N., Nutting, P., Camp, P. and Wells, K. B. (1999), Treating Depression in Staff-Model Versus Network-Model Managed Care Organizations. Journal of General Internal Medicine, 14: 39–48. doi: 10.1046/j.1525-1497.1999.00279.x
- Issue published online: 25 DEC 2001
- Article first published online: 25 DEC 2001
- Cited By
- primary care;
- managed care
To compare primary care providers’ depression-related knowledge, attitudes, and practices and to understand how these reports vary for providers in staff or group-model managed care organizations (MCOs) compared with network-model MCOs including independent practice associations and preferred provider organizations.
Survey of primary care providers’ depression-related practices in 1996.
SETTING AND PARTICIPANTS:
We surveyed 410 providers, from 80 outpatient clinics, in 11 MCOs participating in four studies designed to improve the quality of depression care in primary care.
MEASUREMENTS AND MAIN RESULTS:
We measured knowledge based on depression guidelines, attitudes (beliefs about burden, skill, and barriers) related to depression, and reported behavior. Providers in both types of MCO are equally knowledgeable about treating depression (better knowledge of pharmacologic than psychotherapeutic treatments) and perceive equivalent skills in treating depression. However, compared with network-model providers, staff/group-model providers have stronger beliefs that treating depression is burdensome to their practice. While more staff/group-model providers reported time limitations as a barrier to optimal depression treatment, more network-model providers reported limited access to mental health specialty referral as a barrier. Accordingly, these staff/group-model providers are more likely to treat patients with major depression through referral (51% vs 38%) or to assess but not treat (17% vs 7%), and network-model providers are more likely to prescribe antidepressants (57% vs 6%) as first-line treatment.
Whereas the providers from staff/group-model MCOs had greater access to and relied more on referral, the providers from network-model organizations were more likely to treat depression themselves. Given varying attitudes and behaviors, improving primary care for the treatment of depression will require unique strategies beyond enhancing technical knowledge for the two types of MCOs.