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

Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness

“…25,29 Codes were initially broadly categorized according to three domains of patient care explored in the interviews: patient, physician and healthcare system factors. 23 Then, two other team-members (I.A.B and E.A.B) independently coded two of the interviews. They worked with D.F.L.…”

“…Interview questions addressed the following domains: patient factors, physician perceptions of competency, and healthcare system issues. 23 In order to facilitate this discussion, physicians were asked to bring de-identified notes from three patients they considered complex to refer to in the interview. Before the interview, we emailed providers the following definition of complexity:…”

Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial

“…[9][10][11] The considerable heterogeneity in outcomes of practice-focused interventions suggests that practice context, such as structural and demographic features and practice culture, may influence successful program implementation. 4,9,[12][13][14][15][16][17][18][19][20] However, studies of primary care practices rarely follow up primary analyses with careful examination of how practice context interacts with intervention approaches to affect outcomes.…”

Association of General Medical and Psychiatric Comorbidities With Receipt of Guideline-Concordant Care for Depression

“…For example, patients with medical comorbidity may be more likely to receive depression treatment in the primary care sector, while those with psychiatric comorbidity may be treated in the specialty sector; in turn, provider specialty might affect adequacy of depression treatment. Those with more comorbidity may have more contacts with the healthcare system and hence greater opportunity to obtain depression treatment, suggesting that both medical and psychiatric comorbidities lead to better quality of depression care [1, 6]. Conversely, primary care clinicians (PCCs) may have limited time and resources to meet clinical goals for both mental illness and chronic medical disease, implying that medical comorbidity will “crowd out” high-quality depression care [4, 6-9].…”

“…Among elderly Americans with depression, those with hypertension or diabetes (but not heart disease or arthritis) were more likely to get guideline-concordant care [11]. Other studies have not found statistically significant adjusted associations of medical comorbidity with quality of depression treatment [1, 4, 6, 12, 13]. …”