TY - JOUR
KW - Aged
KW - Antidepressive Agents/therapeutic use
KW - Cooperative Behavior
KW - Depressive Disorder/ethnology/therapy
KW - Female
KW - Humans
KW - Male
KW - Mental Health Services/standards/utilization
KW - Minority Groups/psychology
KW - Models, Organizational
KW - Outcome Assessment (Health Care)
KW - Patient Care Team/standards
KW - Patient Satisfaction/ethnology
KW - Primary Health Care/standards
KW - Psychotherapy
KW - Quality Assurance, Health Care
KW - Severity of Illness Index
KW - United States/epidemiology
AU - P. A. Arean
AU - L. Ayalon
AU - E. Hunkeler
AU - E. H. Lin
AU - L. Tang
AU - L. Harpole
AU - H. Hendrie
AU - J. W. Williams
AU - J. Unutzer
AU - IMPACT Investigators
A1 - 
AB - OBJECTIVE: Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving depression treatment and outcomes. STUDY DESIGN: A multisite randomized clinical trial of 1801 older adults comparing collaborative care for depression with treatment as usual in primary care. Twelve percent of the sample were black (n = 222), 8% were Latino (n = 138), and 3% (n = 53) were from other minority groups. We compared the 3 largest ethnic groups (non-Latino white, black, and Latino) on depression severity, quality of life, and mental health service use at baseline, 3, 6, and 12 months after randomization to collaborative care or usual care. PRINCIPAL FINDINGS: Compared with care as usual, collaborative care significantly improved rates and outcomes of depression care in older adults from ethnic minority groups and in older whites. At 12 months, intervention patients from ethnic minorities (blacks and Latinos) had significantly greater rates of depression care for both antidepressant medication and psychotherapy, lower depression severity, and less health-related functional impairment than usual care participants (64%, 95% confidence interval [CI] 55-72 versus 45%, CI 36-55, P = 0.003 for antidepressant medication; 37%, CI 28-47 versus 13%, CI 6-19, P = 0.002 for psychotherapy; mean = 0.9, CI 0.8-1.1 versus mean = 1.4, CI 1.3-1.5, P < 0.001 for depression severity, range 0-4; mean = 3.7, CI 3.2-4.1, versus mean = 4.7, CI 4.3-5.1, P < 0.0001 for functional impairment, range 0-10). CONCLUSIONS: Collaborative Care is significantly more effective than usual care for depressed older adults, regardless of their ethnicity. Intervention effects in ethnic minority participants were similar to those observed in whites.
BT - Medical care
C5 - Healthcare Disparities; Key & Foundational
CP - 4
CY - United States
IS - 4
JF - Medical care
N2 - OBJECTIVE: Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving depression treatment and outcomes. STUDY DESIGN: A multisite randomized clinical trial of 1801 older adults comparing collaborative care for depression with treatment as usual in primary care. Twelve percent of the sample were black (n = 222), 8% were Latino (n = 138), and 3% (n = 53) were from other minority groups. We compared the 3 largest ethnic groups (non-Latino white, black, and Latino) on depression severity, quality of life, and mental health service use at baseline, 3, 6, and 12 months after randomization to collaborative care or usual care. PRINCIPAL FINDINGS: Compared with care as usual, collaborative care significantly improved rates and outcomes of depression care in older adults from ethnic minority groups and in older whites. At 12 months, intervention patients from ethnic minorities (blacks and Latinos) had significantly greater rates of depression care for both antidepressant medication and psychotherapy, lower depression severity, and less health-related functional impairment than usual care participants (64%, 95% confidence interval [CI] 55-72 versus 45%, CI 36-55, P = 0.003 for antidepressant medication; 37%, CI 28-47 versus 13%, CI 6-19, P = 0.002 for psychotherapy; mean = 0.9, CI 0.8-1.1 versus mean = 1.4, CI 1.3-1.5, P < 0.001 for depression severity, range 0-4; mean = 3.7, CI 3.2-4.1, versus mean = 4.7, CI 4.3-5.1, P < 0.0001 for functional impairment, range 0-10). CONCLUSIONS: Collaborative Care is significantly more effective than usual care for depressed older adults, regardless of their ethnicity. Intervention effects in ethnic minority participants were similar to those observed in whites.
PP - United States
PY - 2005
SN - 0025-7079; 0025-7079
SP - 381
EP - 390
EP - 
T1 - Improving depression care for older, minority patients in primary care
T2 - Medical care
TI - Improving depression care for older, minority patients in primary care
U1 - Healthcare Disparities; Key & Foundational
U2 - 15778641
VL - 43
VO - 0025-7079; 0025-7079
Y1 - 2005
ER -