Using Behavioral Science to Explain PCP Depression Care

描述（由申请人提供）：改善抑郁症的护理是一个 精神卫生服务研究的基本目标。需要改善护理 在初级保健中尤其重要，因为大多数患者接受护理 在这种情况下，初级保健提供者（PCP）的行为是关键 实现改进的工具。本申请（响应PAR 99 -073） 旨在加强对供应商之间潜在关系的理解 态度、意图和PCP治疗行为，以改善对 萧条多学科研究小组将检查和比较 从社会和行为科学中选择理论，以获得新的见解 五氯酚抑郁症治疗行为这项工作将提出一些老问题， 通过应用和整合模式以新的方式改善精神卫生保健 传统上用于研究个人健康行为来研究PCP抑郁症 治疗行为应用这些框架的经验教训可以为 未来的干预措施，改变提供者的行为，以改善抑郁症护理。 这些目标将通过对数据的二次分析来解决， 414名PCP和2，030名重度抑郁症患者（每位提供者5-15名）的样本 参与四个抑郁症质量改善联盟 问题研究这些PCP来自11个不同的管理式医疗中的80个不同的诊所 很少有数据库包含广泛的结构 需要广泛的理论测试与相对较大的样本， 提供商回归和结构方程分析将阐明 在多大程度上选定的社会和卫生期望值框架 心理学和行为经济学的代理理论解释了供应商 抑郁症治疗行为这些适应性理论的相对功效 将进行比较（使用方差解释和相对优度指标 适合），以确定最有用的组合PCP态度，行为 意图和治疗选择在建模PCP抑郁症治疗 行为我们还将概述模型的优点和缺点， 不同的学科。

DESCRIPTION (provided by applicant): Improving care for depression is a fundamental goal of mental health services research. The need to improve care within primary care is particularly relevant because most patients receive care solely within that setting. Primary care provider (PCP) behavior is a key vehicle for achieving improvement. This application (responding to PAR99-073) aims to enhance the understanding of underlying relationships among provider attitudes, intentions, and PCP treatment behavior to improve care for depression. The multidisciplinary research team will examine and compare selected theories from the social and behavioral sciences to gain new insights into PCP depression treatment behavior. This work will ask old questions about improving mental health care in new ways by applying and integrating models traditionally used to study personal health behavior to study PCP depression treatment behavior. Lessons from application of these frameworks could inform future interventions for changing provider behavior to improve depression care. These objectives will be addressed through secondary analyses of data from a sample of 414 PCPs and 2,030 patients (5-15 per provider) with major depression participating in the four Quality Improvement for Depression consortium studies. These PCPs are from 80 different clinics in 11 different managed care organizations across the U.S. Few databases contain the breadth of constructs necessary for broad theoretical testing with a relatively large sample of providers. Regression and structural equation analyses will elucidate the degree to which the selected expectancy-value frameworks from social and health psychology, and agency theory from behavioral economics explain provider depression treatment behavior. The relative efficacy of these adapted theories will be compared (using indicators of variance explained and relative goodness of fit) to identify the most useful combination of PCP attitudes, behavioral intentions, and treatment choices in modeling PCP depression treatment behavior. We will also outline the strengths and weaknesses of the models from the different disciplines.