1070 — PC-MHI Provider Staffing and Quality of Depression Care

Levine DS, COIN- Ann Arbor; McCarthy J, COIN- Ann Arbor; Cornwell B, COIN- Ann Arbor; Brockman L, COIN - Ann Arbor; Pfeiffer P, COIN - Ann Arbor;

Objectives:
The structure of Primary Care - Mental Health Integration (PC-MHI) programs vary widely in VA, and this variation may impact the quality of related care processes. In particular, the type of mental health care providers in PC-MHI programs and provider-to-patient ratios may impact the quality of antidepressant medication or psychotherapy treatment for depression. As part of national VA PC-MHI evaluation activities, this analysis examines how staffing relates to treatment receipt to help design more effective PC-MHI programs.

Methods:
VA outpatient encounter data were used to assess receipt of depression care (any antidepressant receipt following a new diagnosis, adequate antidepressant supply during acute phase of treatment, any psychotherapy receipt, and receipt of 3+ psychotherapy encounters within 90 days of diagnosis) in any setting among patients diagnosed with depression in primary care in FY2013 after a 1-year period without a depression diagnosis. PC-MHI staffing ratios (FTEs per 10,000 patients) based on the 2013 National PC-MHI Evaluation Survey were grouped as follows: psychologists, social workers, prescribers (psychiatrists and nurse practitioners with prescriptive authority), and registered nurses. In multiple regressions, we assessed associations between staffing and services receipt, adjusting for age, gender, race/ethnicity, comorbid PTSD, other anxiety, bipolar disorder, substance use disorder, facility size and type, and rurality.

Results:
Social worker (B(SE) = 1.20(0.51), p = 0.02) and psychologist (B(SE) = 1.01(0.51), p = 0.05) staffing ratios were associated with an increased likelihood of any antidepressant use, and social worker staffing ratios (B(SE) = 1.29(0.49),p < .01) were also associated with adequate acute phase antidepressant treatment. Psychologist and social worker staffing ratios were also associated with an increased likelihood of any psychotherapy receipt (B(SE) = 1.94(0.62), p < 0.01 and B(SE) = 2.23(0.62), p < 0.01, respectively) and receipt of 3+ psychotherapy encounters (B(SE) = 0.97(0.37),p < .01) and B(SE) = 0.97(0.37),p < .01), respectively). Prescriber and registered nurse staffing ratios were not associated with treatment indicators.

Implications:
PC-MHI provider types were differentially associated with receipt of depression care with social worker and psychologist staffing ratios demonstrating significant associations with higher rates of treatment.

Impacts:
PC-MHI staffing was associated with increased treatment for primary care patients with depression. Findings can inform operations and policy efforts to determine the optimal PC-MHI staffing to improve depression care processes.