Prevalence of Practice System Tools for Improving Depression Care Among Primary Care Clinics: The DIAMOND Initiative

BACKGROUND: Practice system tools improve chronic disease care, but are generally lacking for the care of depression in most primary care settings. OBJECTIVE: To describe the frequency of various depression-related practice system tools among Minnesota primary care clinics interested in improving depression care. DESIGN: Cross-sectional survey. PARTICIPANTS: Physician leaders of 82 clinics in Minnesota. MAIN MEASURES: A survey including practice systems recommended for care of depression and chronic conditions, each scored on a 100-point scale, and the clinic's priority for improving depression care on a 10-point scale. KEY RESULTS: Fewer practice systems tools were present and functioning well for depression care (score = 24.4 [SD 1.6]) than for the care of chronic conditions in general (score = 43.9 [SD 1.6]), p < 0.001. The average priority for improving depression care was 5.8 (SD 2.3). There was not a significant correlation between the presence of practice systems for depression or chronic disease care and the priority for depression care except for a modest correlation with the depression Decision Support subscale (r = 0.29, p = 0.008). Certain staffing patterns, a metropolitan-area clinic location, and the presence of a fully functional electronic medical record were associated with the presence of more practice system tools. CONCLUSIONS: Few practice system tools are in place for improving depression care in Minnesota primary care clinics, and these are less well-developed than general chronic disease practice systems. Future research should focus on demonstrating whether implementing these tools for depression care results in much-needed improvements in care for patients with depression.