Barriers in Implementing Evidence-Based Collaborative Care for Depression: Providers' Perspectives on Comfort and Difficulty Delivering Depression Care in Primary Care

To date, widespread adoption, implementation, diffusion and sustainability of evidence-based collaborative care management (CCM) models for mental health/primary care integration, in which primary care (PC) depression treatment is supported by nurse care managers and mental health specialists (MHS), has been limited. To further research this, we designed and distributed a self-administered survey, which investigated provider and organizational facilitators/barriers during initial implementation of a CCM model, in 8 CCM Veterans Administration sites. Principal Components Analyses were used to define Comfort Providing Depression Care and PC Provider Difficulty Providing Depression Care scales from survey data. A 53% response (N=183/346 eligible providers) resulted. Two separate regression models using the Comfort, and Difficulty, scales as dependent variables were tested. The Comfort Model was significant, F (8,121)= 13.12, p <.0001: Providers' comfort co-managing depression with a depression care manager (p<.0001), and experience providing depression care (p<.0001) explained 46% of the variance. Residents (p=.084), nurse practitioners and physician assistants (p=.092), tended to be less comfortable managing, diagnosing, educating and assessing depression than non-resident MDs. The Difficulty Model was also significant, F (8,119)=15.68, p<.0001: Number of persons with depression a provider saw during a half day session (p=.019), providers' experience providing depression care (p<.0001), and providers' communications with a MHS (p=.042), explained 51% of the variance. Barriers to successful CCM model implementation in PC can possibly be reduced if targeted planning/training addresses provider workload levels, relevant experience and availability of collaboration.