ArticleJournal of general internal medicine2008
Clinician burden and depression treatment: disentangling patient- and clinician-level effects of medical comorbidity.
Article in Journal of general internal medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial.Journal of general internal medicine · 2015Trial
- Modeling effect: How treatment intensity and duration impact depression recurrence.European psychiatry : the journal of the Association of European Psychiatrists · 2025Article
- Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study.European psychiatry : the journal of the Association of European Psychiatrists · 2022Article
- Primary care providers' experiences caring for complex patients in primary care: a qualitative study.BMC family practice · 2016Article
- Integrated care: treatment initiation following positive depression screens.Journal of general internal medicine · 2013Article
- Quality of care for major depression and its determinants: a multilevel analysis.BMC psychiatry · 2012Article
- Primary care physician perceptions on caring for complex patients with medical and mental illness.Journal of general internal medicine · 2012Article
- Pre-post evaluation of automated reminders may improve detection and management of post-stroke depression.Journal of general internal medicine · 2011Article
- Association of general medical and psychiatric comorbidities with receipt of guideline-concordant care for depression.Psychiatric services (Washington, D.C.) · 2010Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundEfforts to improve primary care depression treatment have assessed strategies across heterogeneous groups of patients, but few have examined clinician-level influences on depression treatment.
objectiveTo examine clinician characteristics that affect depression treatment in primary care settings, using multilevel ordinal regression modeling to disentangle patient- from clinician-level effects.
designSecondary analysis from the Quality Improvement in Depression Study dataset.
participantsThe participants were 1,023 primary care patients with depression who reported on treatment in the 6-month follow-up and whose clinicians (n = 158) had at least 4 patients in the study. MEASUREMENTS: Primary outcome variable was depression treatment intensity, derived from assessment of concordance with AHCPR depression treatment guidelines based on patient-reported data on their treatment. Primary independent variable was clinical practice burden for treating depression, derived from patient- and clinician-reported composite measures tested for significant association with clinician-reported practice burden.
resultsClinicians who treat patients with more chronic medical comorbidities perceive less burden from treating depressed patients in their practice (Spearman's rho = -.30, p < .05). Clinicians who treat patients with more chronic medical comorbidities also provide greater intensity of depression treatment (adjusted OR = 1.44, p = .02), even after adjusting for the effects of patient-level chronic medical comorbidities (adjusted OR = 0.95, p = .45).
conclusionsClinicians who provide more chronic care also provide greater depression treatment intensity, suggesting that clinicians who care for complex patients can integrate depression care into their practice. Targeting interventions to these clinicians to enhance their ability to provide guideline-concordant depression care is a worthwhile endeavor and deserves further investigation.
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