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Related Experiment Videos

Treating depression in staff-model versus network-model managed care organizations

L S Meredith1, L V Rubenstein, K Rost

  • 1RAND, Santa Monica, Calif 90407, USA.

Journal of General Internal Medicine
|January 20, 1999
PubMed
Summary

Primary care providers in different managed care organizations (MCOs) show similar depression knowledge but varying treatment approaches. Staff/group-model providers rely more on referrals, while network-model providers are more likely to prescribe antidepressants.

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Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Mental Health Services

Background:

  • Primary care providers (PCPs) play a crucial role in managing depression.
  • Managed care organizations (MCOs) influence how PCPs deliver care.
  • Understanding differences in depression care across MCO models is essential for quality improvement.

Purpose of the Study:

  • To compare depression-related knowledge, attitudes, and practices among PCPs in staff/group-model MCOs versus network-model MCOs.
  • To identify how MCO structure impacts depression care delivery.

Main Methods:

  • A 1996 survey assessed depression-related knowledge, attitudes, and practices of 410 PCPs across 80 outpatient clinics in 11 MCOs.
  • Knowledge was measured against depression guidelines; attitudes included beliefs about burden, skill, and barriers.

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  • Reported behaviors included treatment and referral patterns.

    • Main Results:

    • PCPs in both MCO types demonstrated equal knowledge of depression treatment, with better pharmacologic than psychotherapeutic knowledge.
    • Staff/group-model providers perceived depression treatment as more burdensome and cited time limitations as barriers.
    • Network-model providers reported limited access to mental health referrals as a barrier.
    • Staff/group-model providers were more likely to refer or assess-but-not-treat depression (51% vs 38% referral).
    • Network-model providers were more likely to prescribe antidepressants as first-line treatment (57% vs 6%).

    Conclusions:

    • PCPs in staff/group-model MCOs utilized referrals more, while network-model PCPs were more inclined to treat depression directly.
    • Differences in attitudes and reported barriers necessitate tailored strategies for improving depression care in primary settings.
    • Enhancing technical knowledge alone is insufficient; MCO-specific approaches are needed for effective depression management.