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Research ArticleOriginal Research

How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

Leif I. Solberg, A. Lauren Crain, Lisa Rubenstein, Jürgen Unützer, Robin R. Whitebird and Arne Beck
The Journal of the American Board of Family Medicine March 2014, 27 (2) 199-208; DOI: https://doi.org/10.3122/jabfm.2014.02.130164
Leif I. Solberg
the HealthPartners Institute for Education and Research, Minneapolis, MN (LIS, ALC, RRW); the RAND Corporation, Santa Monica, CA (LR); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (JU); and Kaiser Permanante Colorado, Denver (AB).
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A. Lauren Crain
the HealthPartners Institute for Education and Research, Minneapolis, MN (LIS, ALC, RRW); the RAND Corporation, Santa Monica, CA (LR); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (JU); and Kaiser Permanante Colorado, Denver (AB).
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Lisa Rubenstein
the HealthPartners Institute for Education and Research, Minneapolis, MN (LIS, ALC, RRW); the RAND Corporation, Santa Monica, CA (LR); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (JU); and Kaiser Permanante Colorado, Denver (AB).
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Jürgen Unützer
the HealthPartners Institute for Education and Research, Minneapolis, MN (LIS, ALC, RRW); the RAND Corporation, Santa Monica, CA (LR); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (JU); and Kaiser Permanante Colorado, Denver (AB).
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Robin R. Whitebird
the HealthPartners Institute for Education and Research, Minneapolis, MN (LIS, ALC, RRW); the RAND Corporation, Santa Monica, CA (LR); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (JU); and Kaiser Permanante Colorado, Denver (AB).
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Arne Beck
the HealthPartners Institute for Education and Research, Minneapolis, MN (LIS, ALC, RRW); the RAND Corporation, Santa Monica, CA (LR); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (JU); and Kaiser Permanante Colorado, Denver (AB).
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Article Figures & Data

Tables

    • View popup
    Table 1. Shared Decision-Making Questions (N = 1168 Respondents)
    QuestionsYes Responses (%)
    During the past 6 months of depression treatment, were you:
    1. Asked for your ideas and preferences regarding your depression treatment?37.0
    2. Asked about your concerns and questions with regard to depression treatment?57.6
    3. Sure that your doctor considered your values and goals when recommending treatment?75.2
    4. Provided with a treatment plan you could do in your daily life?60.6
    5. Asked about any problems or side effects from your treatments?42.4
    6. Asked whether you preferred medications or counseling?34.2
    Composite (standard deviation)50.7 (32.8)
    • View popup
    Table 2. Personal, Clinic, and Group Characteristics of 1168 Enrolled Patients
    CharacteristicsNo.%
    Patients
        Sex
            Female85172.9
            Male31727.1
        Age (years)
            18–3434429.5
            35–4939133.5
            50–6434739.7
             ≥65867.4
        Ethnicity/race
            Non-Hispanic white102287.5
            Hispanic, any race433.7
            Non-Hispanic, nonwhite1038.8
        Treated for this depression
            0–5 weeks54346.5
            ≥6 weeks60752.0
        Other depression treatment in past 6 months
            Individual counseling29925.6
            Group therapy453.8
            Psychiatry695.9
            Other treatment413.5
            Any treatment37632.2
        General health
            Excellent/very good38332.8
            Good43737.4
            Fair/poor34829.8
        PHQ-9 score
            7–936731.4
            10–1444638.2
            15–1924420.9
            ≥201119.5
        Education
            High school or less35530.4
            Some college, trade school46840.1
            College degree or more34529.5
        Marital status
            Married56948.7
            Unmarried couple1018.6
            Divorced/separated/widowed26822.9
            Never married22919.6
        Employment
            Employed for wages69659.6
            Self-employed695.9
            Unemployed11710.0
            Homemaker453.9
            Student474.0
            Retired827.0
            Unable to work1129.6
        Household income
            Below poverty threshold20517.5
            Between threshold and 2× threshold16614.2
            More than 2× threshold74964.1
            Declined to answer484.1
        Insurance type
            Commercial79267.8
            State programs*27023.1
            Medicare615.2
            Other342.9
    Clinics
        Adult PCPs in clinic (n)
            1–415913.6
            5–1051043.7
            ≥1149742.6
        NPs/PAs in clinic (n)
            012410.6
            ≥1104489.4
        Clinic location
            Urban71461.1
            Rural45438.9
    Medical groups
        Care sites in group (n)
            1–427423.5
            5–10988.4
            ≥1179668.2
        Psychiatrists in group (n)
            039033.4
            ≥177866.6
        Mental health therapists in group (n)
            038533.0
            ≥178367.0
    • ↵* Medical Assistance, Prepaid Medical Assistance, Minnesota Care, Minnesota Senior Health Options.

    • NP, nurse practitioner; PA, physician assistant; PCP, primary care physician; PHQ-9, 9-item Patient Health Questionnaire.

    • View popup
    Table 3. Bivariate Relationships Between Patient, Clinic, and Group Characteristics and Shared Decision Making
    CharacteristicsNo.Mean*SDP Value
    Patients
        Sex
            Female84851.233.0.40
            Male31449.432.2
        Age (years)
            18–3434358.331.0.03
            35–4939053.332.4
            50–6434544.532.8<.001
            ≥658432.731.1<.0001
        Ethnicity/race
            Non-Hispanic white101650.433.2
            Hispanic, any race4345.730.9.36
            Non-Hispanic, nonwhite10355.829.4.11
        Treated for this depression
            0–5 weeks54056.629.7<.001
            ≥6 weeks60445.534.5
        Any other depression treatment in past 6 months
            No78846.033.1
            Yes37160.530.0<.0001
        General health
            Excellent/very good/good81553.932.1
            Fair/poor34743.133.2<.001
        PHQ-9 score
            7–936451.632.0.75
            10–1444450.833.5
            15–1924349.932.6.71
            ≥2011149.133.2.62
        Education
            High school or less35447.231.6.02
            Some college, trade school46651.532.7.46
            College degree or more34253.234.0
        Marital status
            Coupled66651.632.5
            Not coupled49549.433.2.26
        Employment
            Employed76152.932.4
            Not employed40146.533.2.001
        Household income
            Below 2× poverty threshold38949.132.5
            Above 2× poverty threshold74452.033.1.15
        Insurance type
            Commercial78752.233.1
            State programs27052.131.8.95
            Medicare6029.427.8<.0001
            Other3442.630.2.09
    Clinics
        Adult PCPs in clinic (n)
            1–415949.532.3
            5–1050651.632.4
            ≥1149550.033.5
        NPs/PAs in clinic (n)
            012250.331.3
            ≥1103850.733.0
        Clinic location
            Urban70950.132.8
            Nonurban45351.632.8
    Medical groups
        Care sites in group (n)
            1 to 427354.132.2
            5 to 109844.430.5
            ≥1179150.333.2
        Psychiatrists in group (n)
            038950.331.6
            ≥177350.933.4
        Mental health therapists in group (n)
            038451.431.6
            ≥177850.333.4
    • ↵* Mean percentage of 6 items answered yes.

    • NP, nurse practitioner; PA, physician assistant; PCP, primary care physician; PHQ-9, 9-item Patient Health Questionnaire; SD, standard deviation.

    • View popup
    Table 4. Multivariate Model-Predicted Differences in Shared Decision Making Among Selected Patient Subgroups Relative to a Reference Group
    CharacteristicsOnly Main EffectsMain Effects Plus Interaction
    DifferenceP Value*DifferenceP Value*
    Sex
        FemaleRefRef
        Male−2.2.29N/A
    Age (years)
        18–344.2.084.1.08
        35–49RefRef
        50–64−7.6.001−7.8<.001
        ≥65−16.0<.001−15.9<.001
    Ethnicity/race
        Non-Hispanic whiteRefRef
        Hispanic, any race−5.0.31N/A
        Non-Hispanic, nonwhite4.2.21N/A
    Treated for this depression
        0–5 weeksRefRef
        ≥6 weeks−11.0<.001−11.2<.001
    Any other depression treatment in past 6 months
        NoRefRef
        Yes14.0<.000114.0<.001
    General health
        Excellent/very good/goodRefRef
        Fair/poor−7.5<.001N/A
    Household income
        Below 2× poverty threshold−4.2.04−3.9.06
        Above 2× thresholdRefRef
    General health by sex
        Female
            Excellent/very good/goodRef
            Fair/poor−4.7.05
        Male
            Excellent/very good/good0.8.74
            Fair/poor−10.0<.03
    • ↵* P value compares predicted difference to reference category.

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The Journal of the American Board of Family     Medicine: 27 (2)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 2
March-April 2014
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How Much Shared Decision Making Occurs in Usual Primary Care of Depression?
Leif I. Solberg, A. Lauren Crain, Lisa Rubenstein, Jürgen Unützer, Robin R. Whitebird, Arne Beck
The Journal of the American Board of Family Medicine Mar 2014, 27 (2) 199-208; DOI: 10.3122/jabfm.2014.02.130164

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How Much Shared Decision Making Occurs in Usual Primary Care of Depression?
Leif I. Solberg, A. Lauren Crain, Lisa Rubenstein, Jürgen Unützer, Robin R. Whitebird, Arne Beck
The Journal of the American Board of Family Medicine Mar 2014, 27 (2) 199-208; DOI: 10.3122/jabfm.2014.02.130164
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