TY - JOUR
AU - S. T. Savitz
AU - A. M. Chamberlain
AU - R. Jiang
AU - S. Sarwar
AU - M. D. Williams
A1 - 
AB - PURPOSE: The Collaborative care model (CoCM) is the leading model for integrating behavioral health into primary care for patients with major depressive disorder (MDD). However, CoCM requires engagement and ongoing participation. We aimed to assess whether two area-based measures, the area-deprivation index (ADI) and rurality, were associated with enrollment, participation, and outcomes with CoCM. METHODS: This was an observational analysis of Mayo Clinic patients eligible for CoCM: adults aged ≥18 years, empaneled in primary care, and with a PHQ-9 of ≥10. We operationalized ADI as quintiles with Q1 being least deprived and Q5 being most deprived and rurality using RUCA codes with two categories: urban and rural. We evaluated enrollment in CoCM, drop out defined by leaving the program early, the count and type of contacts with the care coordinator, and clinical improvement measured using the PHQ-9. FINDINGS: We identified 54,030 individuals with 16,532 (30.6%) residing in rural areas and 11,122 (20.6%) residing in the most deprived ADI quintile (Q5). Living in a rural area was associated with lower enrollment in CoCM (-2.3 percentage points [95% confidence interval (CI): -2.5, 2.2]), longer length in CoCM (18.6 days [95% CI: 5.7, 31.5]), more contacts with the care coordinator (1.1 contacts [95% CI: 0.2, 2.0]), and worse response and remission. In contrast, ADI Q5 was only associated with worse response and remission. CONCLUSIONS: Rurality was associated with lower enrollment, greater engagement, and worse clinical outcomes. More work may be needed to address enrollment barriers for individuals living in rural areas to improve clinical outcomes.
AD - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.; Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, USA.; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.; Sheppard and Enoch Pratt Hospital, Towson, Maryland, USA.; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA.
AN - 40545556
BT - J Rural Health
C5 - Healthcare Disparities
CP - 3
DA - Jun
DO - 10.1111/jrh.70044
DP - NLM
IS - 3
JF - J Rural Health
LA - eng
N2 - PURPOSE: The Collaborative care model (CoCM) is the leading model for integrating behavioral health into primary care for patients with major depressive disorder (MDD). However, CoCM requires engagement and ongoing participation. We aimed to assess whether two area-based measures, the area-deprivation index (ADI) and rurality, were associated with enrollment, participation, and outcomes with CoCM. METHODS: This was an observational analysis of Mayo Clinic patients eligible for CoCM: adults aged ≥18 years, empaneled in primary care, and with a PHQ-9 of ≥10. We operationalized ADI as quintiles with Q1 being least deprived and Q5 being most deprived and rurality using RUCA codes with two categories: urban and rural. We evaluated enrollment in CoCM, drop out defined by leaving the program early, the count and type of contacts with the care coordinator, and clinical improvement measured using the PHQ-9. FINDINGS: We identified 54,030 individuals with 16,532 (30.6%) residing in rural areas and 11,122 (20.6%) residing in the most deprived ADI quintile (Q5). Living in a rural area was associated with lower enrollment in CoCM (-2.3 percentage points [95% confidence interval (CI): -2.5, 2.2]), longer length in CoCM (18.6 days [95% CI: 5.7, 31.5]), more contacts with the care coordinator (1.1 contacts [95% CI: 0.2, 2.0]), and worse response and remission. In contrast, ADI Q5 was only associated with worse response and remission. CONCLUSIONS: Rurality was associated with lower enrollment, greater engagement, and worse clinical outcomes. More work may be needed to address enrollment barriers for individuals living in rural areas to improve clinical outcomes.
PY - 2025
SN - 0890-765x
SP - e70044
ST - Impact of rurality and the area deprivation index on outcomes of collaborative care for depression
T1 - Impact of rurality and the area deprivation index on outcomes of collaborative care for depression
T2 - J Rural Health
TI - Impact of rurality and the area deprivation index on outcomes of collaborative care for depression
U1 - Healthcare Disparities
U3 - 10.1111/jrh.70044
VL - 41
VO - 0890-765x
Y1 - 2025
ER -