TY - JOUR
KW - Aged
KW - Aged, 80 and over
KW - Antidepressive Agents/therapeutic use
KW - Cooperative Behavior
KW - Depressive Disorder, Major/drug therapy/ethnology/therapy
KW - Educational Status
KW - Ethnic Groups/psychology
KW - Female
KW - Follow-Up Studies
KW - Healthcare Disparities/ethnology
KW - Humans
KW - Male
KW - Mental Health Services
KW - Middle Aged
KW - Prospective Studies
KW - Treatment Outcome
AU - Y. Bao
AU - G. S. Alexopoulos
AU - L. P. Casalino
AU - TR Ten Have
AU - J. M. Donohue
AU - E. P. Post
AU - B. R. Schackman
AU - M. L. Bruce
A1 - 
AB - 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.
BT - Archives of General Psychiatry
C5 - Healthcare Disparities
CP - 6
CY - United States
DO - 10.1001/archgenpsychiatry.2011.55
IS - 6
JF - Archives of General Psychiatry
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.
PP - United States
PY - 2011
SN - 1538-3636; 0003-990X
SP - 627
EP - 636
EP - 
T1 - Collaborative depression care management and disparities in depression treatment and outcomes
T2 - Archives of General Psychiatry
TI - Collaborative depression care management and disparities in depression treatment and outcomes
U1 - Healthcare Disparities
U2 - 21646579
U3 - 10.1001/archgenpsychiatry.2011.55
VL - 68
VO - 1538-3636; 0003-990X
Y1 - 2011
ER -