@article{ref1,
title="Collaborative depression care management and disparities in depression treatment and outcomes",
journal="Archives of general psychiatry",
year="2011",
author="Bao, Yuhua and Alexopoulos, George S. and Casalino, Lawrence P. and ten Have, Thomas R. and Donohue, Julie M. and Post, Edward P. and Schackman, Bruce R. and Bruce, Martha L.",
volume="68",
number="6",
pages="627-636",
abstract="CONTEXT: Collaborative depression care management (DCM), by addressing barriers disproportionately affecting patients of racial/ethnic minority and low education, may reduce disparities in depression treatment and outcomes. OBJECTIVE: To examine the effects of DCM on treatment disparities by education and race/ethnicity in older depressed primary care patients. DESIGN: Analysis of data from the randomized controlled trial Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). SETTING: Twenty primary care practices. PARTICIPANTS: A total of 396 individuals 60 years or older with major depression. We conducted model-based analysis to estimate potentially differential intervention effects by education, independent of those by race/ethnicity (and vice versa). Intervention  Algorithm-based recommendations to physicians and care management by care managers. MAIN OUTCOME MEASURES: Antidepressant use, depressive symptoms, and intensity of DCM over 2 years. RESULTS: The PROSPECT intervention had a larger and more lasting effect in less-educated patients. At month 12, the intervention increased the rate of adequate antidepressant use by 14.2 percentage points (pps) (95% confidence interval [CI], 1.7 to 26.4 pps) in the no-college group compared with a null effect in the college-educated group (-9.2 pps [95% CI, -25.0 to 2.7 pps]); at month 24, the intervention reduced depressive symptoms by 2.6 pps on the Hamilton Depression Rating Scale (95% CI, -4.6 to -0.4 pps) in no-college patients, 3.8 pps (95% CI, -6.8 to -0.4) more than in the college group. The intervention benefitted non-Hispanic white patients more than minority patients. Intensity of DCM received by minorities was 60% to 70% of that received by white patients after the initial phase but did not differ by education. CONCLUSIONS: The PROSPECT intervention substantially reduced disparities by patient education but did not mitigate racial/ethnic disparities in depression treatment and outcomes. Incorporation of culturally tailored strategies in DCM models may be needed to extend their benefits to minorities. Trial Registration  clinicaltrials.gov Identifier for PROSPECT: NCT00279682.<p /> <p>Language: en</p>",
language="en",
issn="0003-990X",
doi="10.1001/archgenpsychiatry.2011.55",
url="http://dx.doi.org/10.1001/archgenpsychiatry.2011.55"
}