Organizational contexts of primary care approaches for managing problem drinking |
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| Authors: | Kathleen Schutte Ph.D. Elizabeth M. Yano Ph.D. M.S.P.H. Amy M. Kilbourne Ph.D. M.P.H. Bhagya Wickrama M.S. JoAnn E. Kirchner M.D. Keith Humphreys Ph.D. |
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| Affiliation: | 1. Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA;2. Veterans Affairs Greater Los Angeles Health Services Research and Development Center of Excellence, Sepulveda, CA and Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA;3. Veterans Affairs Ann Arbor Health Services Research and Development/Severe Mental Illness Treatment, Research, and Evaluation Center, Department of Psychiatry, University of Michigan;4. Formerly at Center for Health Care Evaluation, now at the United Nations Development Programme, Regional Center, Colombo, Sri Lanka;5. South Central Veterans Affairs Mental Illness Research Education Clinical Center, Little Rock, AR, USA;6. Program Evaluation and Resource Center, Veterans Affairs Palo Alto Health Care System, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine |
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| Abstract: | Little is known about the organizational contexts associated with different primary care (PC) approaches to managing PC patients with drinking problems. Relying upon the Chronic Care Model and a theoretically based taxonomy of health care systems, we identified organizational factors distinguishing PC practices using PC-based approaches (managed by PC providers, mental health specialists, or jointly with specialty services) versus referral-based management in the Veterans Affairs health care system. Data were obtained from a national survey of 218 PC practices characterizing usual management approaches as well as practices' leadership, delivery system design, information system, and decision support characteristics and from a national survey of substance use disorder specialty programs. PC- and referral-based practices did not differ on the sufficiency of their structural resources, physician staffing, or on the availability of specialty services. However, PC-based practices were found to take more responsibility for managing patients' chronic conditions and had more staff for decision support activities. |
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| Keywords: | Organizational behavior Primary care Drinking problems Quality improvement |
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