TY  - JOUR
PY  - 2011//
TI  - Collaborative depression care management and disparities in depression treatment and outcomes
JO  - Archives of general psychiatry
A1  - Bao, Yuhua
A1  - Alexopoulos, George S.
A1  - Casalino, Lawrence P.
A1  - ten Have, Thomas R.
A1  - Donohue, Julie M.
A1  - Post, Edward P.
A1  - Schackman, Bruce R.
A1  - Bruce, Martha L.
SP  - 627
EP  - 636
VL  - 68
IS  - 6
N2  - 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>
LA  - en
SN  - 0003-990X
UR  - http://dx.doi.org/10.1001/archgenpsychiatry.2011.55
ID  - ref1
ER  -