Formative evaluation of practice changes for managing depression within a Shared Care model in primary care

Area of Science:

• Primary Care Research
• Mental Health Services
• Health Services Evaluation

Background:

• Manitoba Health's 2006 primary care renewal initiative included the Physician Integrated Network (PIN).
• PIN developed specific mental health indicators for depression screening and follow-up.
• These indicators were piloted in three PIN group practices within Shared Mental Health Care settings.

Purpose of the Study:

• To investigate the implementation process of the PIN mental health indicators.
• To assess the initial impact of these indicators on depression screening and management.
• To understand provider perspectives on using these indicators in primary care.

Main Methods:

• A non-experimental longitudinal design was employed for a formative evaluation.
• Mixed methods, including document review, surveys, and interviews, were utilized.
• Quantitative data were analyzed using descriptive and comparative statistics; qualitative data underwent content and theme analysis.

Main Results:

• Provider attitudes, knowledge, skills, and behaviors regarding depression care were documented.
• Implementation of PIN indicators varied across sites and providers, with increasing usage over time.
• While providers generally felt screening benefits outweighed costs, its definitive impact on depression care was unclear.

Conclusions:

• Depression is a significant, time-consuming issue in primary care requiring further study.
• The effectiveness of screening for depression within primary care warrants further investigation.
• Alternative strategies may be more impactful for managing depression in primary care settings.