Teaching systems-based practice to primary care physicians to foster routine implementation of evidence-based depression care.

Full Abstract

Although health care organizations seeking to improve quality often must change the system for delivering care, there is little available evidence on how to educate staff and providers about this change. As part of a 2002-2003 Veterans Health Administration multisite project using collaborative care to improve the management of depression, the authors implemented the Translating Initiatives for Depression into Effective Solutions (TIDES) program. Five steps were followed for teaching systems-based practice:
(1) determine providers' educational needs (through administrative data, expert opinion, and provider discussion), (2) develop educational materials (based on needs assessed), (3) help each of seven sites develop an educational intervention, (4) implement the intervention, and (5) monitor the intervention's effectiveness. Sites relied primarily on passive educational strategies. There was variable implementation of the different components (e.g., lecture, educational outreach). No site chose to write up its education plan, as was suggested. The authors thus suggest that the educational model was successful at identifying providers' needs and creating appropriate materials, because the program was not advertised in other ways and because almost all providers referred patients to the program. However, the educational model was only partially successful at getting sites to develop and implement an educational plan, although provider behavior did change. Overall, the program was somewhat effective at teaching systems-based practice. The authors believe the best way to enhance effectiveness is to build education into the system rather than rely on a separate system for education.

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Author information

Author/s: Sherman, Scott E (SE); Fotiades, John (J); Rubenstein, Lisa V (LV); Gilman, Stuart C (SC); Vivell, Susan (S); Chaney, Edmund (E); Yano, Elizabeth M (EM); Felker, Bradford (B);

Affiliation: Veterans Health Administration (VA) New York Harbor Healthcare System, New York, New York 10010, USA. scott.sherman(-atsign-)med.nyu.edu

Journal and publication information

Publication Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Review

Journal: Academic medicine : journal of the Association of American Medical Colleges (Acad Med), published in United States. (Language: eng)

Reference: 2007-Feb; vol 82 (issue 2) : pp 168-75

Dates: Created 2007/01/31; Completed 2007/03/16;

PMID: 17264696, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Primary Health Care - organization & administration
Psychiatry - education
Referral and Consultation - organization & administration

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