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Clinician Burden and Depression Treatment: Disentangling Patient- and Clinician-Level Effects of Medical Comorbidity

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Abstract

Background

Efforts to improve primary care depression treatment have assessed strategies across heterogeneous groups of patients, but few have examined clinician-level influences on depression treatment.

Objective

To examine clinician characteristics that affect depression treatment in primary care settings, using multilevel ordinal regression modeling to disentangle patient- from clinician-level effects.

Design

Secondary analysis from the Quality Improvement in Depression Study dataset.

Participants

The 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.

Results

Clinicians 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).

Conclusions

Clinicians 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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Acknowledgements

The authors wish to especially thank Dr. Donald Hedeker for his biostatistical mentorship along with the entire faculty of the NIMH-funded Mentoring and Education for Health Services Research Fellowship and clinician members of the SNOCAP PBRN for their helpful comments on depression and primary care.

Funding support

This project was supported by the National Institute of Mental Health MH070395.

No conflict of interest has been disclosed for any of the authors.

Presented at the North American Primary Care Research Conference, November, 2008

Author information

Authors and Affiliations

  1. Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA

    L. Miriam Dickinson PhD, W. Perry Dickinson MD, Frank deGruy MD, Caroline Emsermann MS, Desireé Froshaug MS & Paul A. Nutting MD, MSPH

  2. Department of Medical Humanities and Social Sciences, Florida State University, Tallahassee, FL, USA

    Kathryn Rost PhD

  3. Rand Health Program, Santa Monica, CA, USA

    Lisa Meredith PhD

  4. UCHSC, Aurora, CO, USA

    L. Miriam Dickinson PhD

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  1. L. Miriam Dickinson PhD
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  2. W. Perry Dickinson MD
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Correspondence to L. Miriam Dickinson PhD.

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Dickinson, L.M., Dickinson, W.P., Rost, K. et al. Clinician Burden and Depression Treatment: Disentangling Patient- and Clinician-Level Effects of Medical Comorbidity. J GEN INTERN MED 23, 1763–1769 (2008). https://doi.org/10.1007/s11606-008-0738-2

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  • DOI: https://doi.org/10.1007/s11606-008-0738-2

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