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Using Behavioral Science to Explain PCP Depression Care
This project aims to enhance the understanding of underlying relationships among primary care provider (PCP) attitudes, perceptions, and practices associated with improving care for depression. This work is asking old questions about improving mental health care in new ways by applying and integrating models traditionally used to study patient preventive behavior, to study provider treatment behavior.
Key aims: 1. Identify PCP attitudes and behavioral intentions that are associated with more (and better) depression care. 2. Determine whether selected expectancy-value theories from social and health psychology can be modified to explain PCP depression treatment behavior. 3. Compare the relative efficacy of these expectancy models to identify the model that has the most potential to characterize PCP treatment behavior using indicators of variance explained and relative goodness of fit. 4. Develop a behavioral economic model based on agency theory to explain PCP depression treatment behavior as a function of discrete treatment choices, while incorporating variables reflecting attitudes and intentions. 5. Outline the strengths and weaknesses of the models derived from the two disciplines to enhance future analyses of provider behavior. Methods: These objectives are being addressed through secondary analyses of data from a sample of 414 PCPs and 2,030 patients (5-15 per provider) with major depression participating in the four Quality Improvement for Depression (QID) consortium studies. These PCPs are from 80 different clinics in 11 different managed care organizations across the U.S. Significance: Numerous studies have documented shortcomings of the health care delivery system, including difficulties associated with guideline adherence by PCPs. Studies have also found that providers feel unprepared and overburdened, making it difficult for them to meet clinical goals of care for patients with chronic illnesses like depression. Through evaluation of the QID data, we can gain an understanding of the relative influences on provider behavior; whether providers are motivated by self-interest, patient benefit (agency), or social good (culture and norms). Given the centrality of PCPs in bringing care to depressed patients, understanding mechanisms for increasing appropriate treatment behaviors is essential for informing organizational and policy decisions around provider education, QI, and practice design. Impact: Lessons from application of these frameworks could inform future interventions for changing provider behavior to improve depression care. Current status: Year 2 analyses and writing. |
Principal Investigators: Lisa Meredith, PhD Sponsored by: |
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Last updated on 4/11/2007 |