A study of depression care perceptions in Texas primary care nurse practitioners

Depression often coexists with chronic illness and presents uniquely in each primary care patient. As Nurse Practitioners (NPs) note the complex nature of the treatment of depression in primary care as well as the prominence, they are also faced with balancing the fine line of mental and physical health of their patient populations. The purpose of this study was to identify and evaluate NPs' perceptions and identification of barriers to depression care in primary care settings in Texas. A mixed methods approach was used in this descriptive study using a convenience sample of 6,356 family and adult Nurse Practitioners (NPs) in Texas (N=121). Participants completed the Demographics and Practice Data questions and the Primary Care Provider Questionnaire (Upshur & Weinreb, 2008). A series of regressions were used to assess the effect of demographics, perceived barriers, and professional characteristics on attitude scores of the Primary Care Provider Questionnaire While there were no significant predictors of attitude scores, a significant multiple linear regression was found predicting skills scores from perceived barriers, and vi professional characteristics. Examination of the individual predictors revealed that participants who agreed that patient resistance and compliance issues were a barrier to education had increased self-ratings of skills in recognizing and treating depression (p < .05). A significant model was also seen in that participants who see more patients on a daily basis are more likely to have lower Satisfaction, Compensation and Adequacy of time scores. Significant predictors of higher behavior scores included indicating that time restrictions are not a treatment barrier (p = .020) and having participated in continuing education (p < .003). Time was noted as an educational barrier by a majority but not selected as often as a treatment barrier. Qualitative responses included themes of challenges and importance of assessment and treatment of depression in patients. While current studies of depression treatment in primary care have focused on physician and other health professionals' attitudes towards depressed clients, very little research has been completed with NPs and their attitudes and perceptions of treatment of depression. This study helps to identify barriers and treatment concerns of depression care in urban and rural Texas. In this environment of managing complex populations of patients, a teamwork approach using ancillary staff such as health educators, nurses, and other care managers will be necessary for NPs to provide the complex physical and mental health care expected in today's healthcare environment.