Depression complexity prevalence and outcomes among veterans affairs patients in integrated primary care.

Introduction: The Veterans Health Administration (VA) Primary Care-Mental Health Integration (PC-MHI) initiative targets depression (MDD), anxiety/posttraumatic stress disorder (PTSD) and alcohol misuse (AM) for care improvement. In primary care, case finding often relies on depression screening. Whereas clinical practice guidelines solely inform management of depression, minimal information exists to guide treatment when psychiatric symptom clusters coexist.

The value of genetic testing: beyond clinical utility.

Objective: To assess the value of genetic testing from the perspective of the Department of Veterans Affairs (VA) clinical leadership.

Methods: We administered an Internet-based survey to VA clinical leaders nationwide. Respondents rated the value (on a 5-point scale) of each of six possible reasons for genetic testing.

Women Veterans with Depression in Veterans Health Administration Primary Care: An Assessment of Needs and Preferences.

Objective: Depression is the most prevalent mental health condition in primary care (PC). Yet as the Veterans Health Administration increases resources for PC/mental health integration, including integrated care for women, there is little detailed information about depression care needs, preferences, comorbidity, and access patterns among women veterans with depression followed in PC.

Methods: We sampled patients regularly engaged with Veterans Health Administration PC.

Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression.

Background: Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed.

Purpose: This study tests whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality.

Methods: We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression.

Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members.

Background: Unclear roles in interdisciplinary primary care teams can impede optimal team-based care. We assessed perceived task allocation among primary care providers (PCPs) and staff during implementation of a new patient-centered care model in Veterans Affairs (VA) primary care practices.

Methods: We performed a cross-sectional survey of PCPs and primary care staff (registered nurses (RNs), licensed practical/vocational nurses (LPNs), and medical assistants/clerks (MAs)) in 23 primary care practices within one VA region.

Veterans with depression in primary care: provider preferences, matching, and care satisfaction.

Primary care is often the first point of care for individuals with depression. Depressed patients often have comorbid alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). Understanding variations in treatment preferences and care satisfaction in this population can improve care planning and outcomes.

Predictors of primary care management of depression in the Veterans Affairs healthcare system.

Background: Primary care providers (PCPs) vary in skills to effectively treat depression. Key features of evidence-based collaborative care models (CCMs) include the availability of depression care managers (DCMs) and mental health specialists (MHSs) in primary care. Little is known, however, about the relationships between PCP characteristics, CCM features, and PCP depression care.

Delivery of clinical genetic consultative services in the Veterans Health Administration.

Objective: To characterize the delivery of genetic consultative services for adults, we examined the prevalence and organizational determinants of genetic consult availability and the organization of these services in the Veterans Health Administration.

Methods: We conducted a Web-based survey of Veterans Health Administration clinical leaders. We summarized facility characteristics using descriptive statistics.

Prevalence and correlates of smoking status among veterans affairs primary care patients with probable major depressive disorder.

In an attempt to guide planning and optimize outcomes for population-specific smoking cessation efforts, the present study examined smoking prevalence and the demographic, clinical and psychosocial characteristics associated with smoking among a sample of Veterans Affairs primary care patients with probable major depression. Survey data were collected between 2003 and 2004 from 761 patients with probable major depression who attended one of 10 geographically dispersed VA primary care clinics. Current smoking prevalence was 39.

Alcohol problems as a risk factor for postdisaster depressed mood among U.S. veterans.

Alcohol problems may impede adaptive, proactive responses to disaster-related injury and loss, thus prolonging the adverse impact of disasters on mental health. Previous work suggests that veterans of the U.S.

Relationships between mood and employment over time among depressed VA primary care patients.

Objective: Associations between depression, productivity and work loss have been reported, yet few studies have examined relationships between longitudinal depression status and employment continuity. We assessed these relationships among Veterans of conventional working ages.

Methods: We used longitudinal survey data from Veterans receiving primary care in 1 of 10 Veterans Health Administration primary care practices in five states.

Impact of the Northridge earthquake on the mental health of veterans: results from a panel study.

Objective: The 1994 earthquake that struck Northridge, California, led to the closure of the Veterans Health Administration Medical Center at Sepulveda. This article examines the earthquake's impact on the mental health of an existing cohort of veterans who had previously used the Sepulveda Veterans Health Administration Medical Center.

Methods: From 1 to 3 months after the disaster, trained interviewers made repeated attempts to contact participants by telephone to administer a repeated measures follow-up design survey based on a survey that had been done preearthquake.

Yield of practice-based depression screening in VA primary care settings.

Background: Many patients who should be treated for depression are missed without effective routine screening in primary care (PC) settings. Yearly depression screening by PC staff is mandated in the VA, yet little is known about the expected yield from such screening when administered on a practice-wide basis.

Objective: We characterized the yield of practice-based screening in diverse PC settings, as well as the care needs of those assessed as having depression.

Potential safety gaps in order entry and automated drug alerts: a nationwide survey of VA physician self-reported practices with computerized order entry.

Objective: Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology.

Design: Cross-sectional, national survey of Veterans Administration physicians practicing in various specialties.

Measurement: Thirty-five question instrument was divided into 4 content domains.

Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice.

Objective: To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice.

Data Sources/study Setting: We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states.

Study Design: In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring.

The evolution of changes in primary care delivery underlying the Veterans Health Administration's quality transformation.

Objectives: Suffering from waning demand, poor quality, and reform efforts enabling veterans to "vote with their feet" and leave, the Veterans Health Administration (VA) health care system transformed itself through a series of substantive changes. We examined the evolution of primary care changes underlying VA's transformation.

Methods: We used 3 national organizational surveys from 1993, 1996, and 1999 that measured primary care organization, staffing, management, and resource sufficiency to evaluate changes in VA primary care delivery.

The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population.

Background: We assessed whether medication safety improved when a medication profiling program was added to a computerized provider order entry system.

Design: Between June 2001 and January 2002 we profiled outpatients with potential prescribing errors using computerized retrospective drug utilization software. We focused primarily on drug interactions.

Exposure to automated drug alerts over time: effects on clinicians' knowledge and perceptions.

Objective: We tested whether interval exposure to an automated drug alert system that included approximately 2000 drug-drug interaction alerts increased recognition of selected interacting drug pairs. We also examined other perceptions about computerized order entry.

Research Design: We administered cross-sectional surveys in 2000 and 2002 that included more than 260 eligible clinicians in each time period.

Gender differences in smoking cessation services received among veterans.

Introduction: Smoking is the leading preventable cause of death among women in the United States. It is a particular problem for women using the Veterans Health Administration (VA), where the prevalence of smoking among women is 30%. We compared the baseline characteristics of male and female smokers and then assessed the smoking cessation services they received to determine whether there are important gender differences in care.

Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

Background: Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates.

Objectives: To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates.

Improving recognition of drug interactions: benefits and barriers to using automated drug alerts.

Background: Clinicians' perceptions about decision support systems may impact the effectiveness of these technologies.

Objective: To explore clinicians' baseline knowledge of common drug interactions and experiences with automated drug alerts within a provider order entry system as a means to better understand the potential benefits and barriers to using this technology.

Research Design: Cross-sectional survey.