Concurrent treatment of patients with depression in the community - Provider practices, attitudes, and barriers to collaboration

BACKGROUND. In randomized controlled trials, patients with major depression who receive broad-based collaborative treatment by both primary care physi cians (PCPs) and mental health providers (MHPs) have better outcomes than p atients who receive usual care. However, little is known about the concurre nt treatment of patients with depression in the community. This study descr ibes the perceptions of PCPs of the frequency of concurrent treatment in co mmunity settings, the degree of collaboration between co-treating providers , and factors associated with greater interaction and collaboration. METHODS. A survey was distributed to a stratified, random sample of 276 eli gible family physicians in Michigan. Primary analyses were descriptive stat istics (point estimation) of PCP practice patterns. Secondary analyses expl ored predictors of collaboration with multivariable regression. RESULTS. A total of 162 eligible PCPs (59%) returned the survey. PCPs repor ted that they co-treated approximately 30% of their depressed patients with MHPs. They made contact with co-treating MHPs in approximately 50% of shar ed cases; however, provider contact seldom included joint treatment plannin g. PCPs perceived collaborative treatments to be more problematic when pati ents were enrolled in managed care programs. In multivariable regression, c o-location of MHP and PCP practices (in the same building) was strongly ass ociated with increased interaction and collaboration (P < .001). CONCLUSIONS. Concurrent treatment of depressed patients is common in the co mmunity, but these treatments are less interactive and collaborative than t he treatment models proven effective in randomized controlled trails. If co ncurrent treatments are to become more collaborative-with regular contact a nd effective communication-co-location of practices appears important.