Understanding Provider Decision-Making
Greer Sullivan MD MSPH
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, AR
Funding Period: February 2010 - July 2013

BACKGROUND/RATIONALE:
Stigma related to mental disorders is known to be widespread and to have devastating effects on the lives of those with mental disorders. A key group who have influence, not only in the lives, but also in the treatment of persons with Serious Mental Illness (SMI) are mental health and primary care providers. Research has suggested that providers who treat SMI patients exhibit considerable stigmatizing attitudes and behaviors towards their patients. The amount and nature of their contact with SMI patients confirms or disconfirms stereotypes. If we better understand provider factors that influence provider decision-making, we can better tailor effective interventions to improve patient outcomes.

OBJECTIVE(S):
Explore the effect of provider specialty (primary care or psychiatry) and type (physician or nurse) on perceptions, beliefs, attitudes and practice behaviors towards persons with SMI. Explore the relationship of provider characteristics (demographics and personality traits) and the amount and nature of contact with SMI to provider attitudes and referral behaviors.

METHODS:
In Phase One the study will employ qualitative methods, using focus groups to develop clinically suitable vignettes to assess perceptions, attitudes, and clinical decision-making among providers. Focus groups will be conducted with consumers, family members, and 4 groups of providers (PCP, PCP nurses, Psychiatrist, Psychiatric nurses). Six consumers with SMI and six family members of the consumers will be invited to participate in focus groups. At total of 24 providers will be recruited to participate in phase one focus groups. Providers will be recruited from both CAVHS and the University of Arkansas for Medical Sciences. The focus group findings will inform the development of a survey, including vignettes and scales, designed to capture provider characteristics potentially associated with provider decision making and patients with SMI. The survey will be used in Phase Two to survey VA providers (PCP, PCP nurses, psychiatrists, psychiatric nurses, and psychologists) at CAVHS, Biloxi, Houston, Oklahoma City, and Jackson. We will recruit a minimum of 54 for each of the four provider groups. (Total N= 270) Survey data will be analyzed using MANOVA (multivariate analysis of variance) and SEM (structural equation models).

FINDINGS/RESULTS:
We have completed phase one and data collection. We are now analyzing the data and planning dissemination workshops. We hypothesize that the measures of provider attitudes, beliefs, and perceptions about seriously mentally ill persons will vary by provider specialty and type; and the difference in clinical decision-making among health providers will be mediated by amount and nature of contact, controlling for provider characteristics.

IMPACT:
Provider stigmatization of patients with SMI is not well understood. We hope to gain valuable insight that may contribute to the development of interventions to improve patient outcomes. We have applied for funds to develop a proto-type intervention.

PUBLICATIONS:

Conference Presentations

1. McComb A, Helmer DA, Corson K, Bair M, Ganzini L, Dobscha S. Positive depression screening in OEF-OIF Veterans is associated with mental healthcare engagement within 30 days. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2010 Nov 9; Denver, CO.

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Prognosis, Treatment - Observational
Keywords: Behavior (provider), Schizophrenia, Serious Mental Illness
MeSH Terms: none