Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

Figures & data

Fig. 1.  Depression screening and follow-up activities at SCF.

Table I. Level of guideline concordant management by depression severity^a

	Mild depression (n = 149)		Moderate depression (n = 150)		Severe depression (n = 101)
	n	%	n	%	n	%
No management	50	34	45	30	15	15
PCC visit without behavioural health addressed	26	17	21	14	5	5
No PCC^b or BHSC^c visit	24	34	24	16	9	9
Declined antidepressant prescription	2	1	9	6	0	0
Missed scheduled appointment	2	1	5	3	1	1
Emergency room visit	4	3	3	2	4	4
Some management^d	0	0	8	5	24	24
PCC visit outside of specified time frame	0	0	6	4	21	21
BHSC visit outside of specified time frame	0	0	2	1	3	3
Guideline concordant management	99	66	97	65	62	61
Antidepressant prescribed	64	47	73	53	55	54
Visit within specified time frame^e	35	24	24	16	7	7
PCC	26	18	18	12	2	2
BHSC	9	6	6	4	5	5

^aAccording to total Patient Health Questionnaire score (mild = score 10–14; moderate = score 15–19; severe = score 20 or higher); ^bprimary care clinic; ^cbehavioural health specialty clinic; ^dbehavioural health addressed at visit outside of time frame specified in Fig. 1; ^ebehavioural health addressed at visit within time frame specified in Fig. 1.

Table II. Guideline concordant management by patient and provider factors

	No management (n=110)		Some management (n=32)		Guideline concordant management (n=258)
	n	%	n	%	n	%
Patient factors^a
PHQ depression severity^b
Mild (score 10–14)	50	34	0	0	99	66
Moderate (score 15–19)	45	30	8	5	97	65
Severe (score 20 or higher)	15	15	24	24	62	61
Gender
Female	86	29	21	7	194	65
Male	24	24	11	11	64	65
Age^b
18–34 years	39	24	5	3	118	73
35–49 years	49	31	18	12	89	57
50–97 years	22	27	9	11	51	62
Number of physical conditions^c
None	77	28	20	7	182	65
1 or more	33	27	12	10	76	63
Number of visits in the year prior to index visit
None	30	28	9	8	70	64
1–7	47	25	12	6	133	69
8 or more	33	33	11	11	55	56
Provider factors^a
Provider gender
Female	74	31	15	6	149	63
Male	36	22	17	11	109	67
Provider tenure
Less than 2 years	22	36	6	10	34	55
2–5 years	66	30	17	8	140	63
5 or more years	22	19	9	8	84	73

Note: Substance abuse not shown due to small cell sizes. ^aAt patient's first visit with positive depression screening during the study period of March 2002 and August 2003; ^bsignificant association (p<0.05) according to the chi-square test of association; ^chypertension, heart disease, diabetes, liver disease, renal disease and pulmonary disease.

Table III. Random intercept ordinal logistic regression on management (no management, some management, guideline concordant management)

	Estimate	Standard error	p-Value	Odds ratio	OR 95% CI
Patient factors^a
PHQ screening score	0.039	0.024	0.098	1.04	0.99–1.09
Gender (reference female)	0.072	0.161	0.654	1.08	0.78–1.48
Age (reference 18–34 years), years
35–49	−0.678	0.266	0.011	0.51	0.30–0.86
50–97	−0.253	0.132	0.055	0.78	0.60–1.01
Number of physical conditions^b	0.003	0.181	0.985	1.00	0.70–1.43
Number of visits in the year prior to first visit in study period	−0.024	0.016	0.133	0.98	0.95–1.01
Provider factors^a
Provider gender (reference female)	0.355	0.200	0.076	1.43	0.96–2.11
Provider tenure ^c	0.095	0.042	0.025	1.10	1.01–1.20
Provider-level variation
Random intercept variation	<0.001	<0.001	0.548	n/a	n/a

^aAt patient's first visit during the study period of March 2002 and August 2003; ^bhypertension, heart disease, diabetes, liver disease, renal disease and pulmonary disease; ^cthe same provider would have different tenure for different patients, varying according to the patient's first visit date. Thus, the variable was entered in the model at the patient level.