TY - JOUR
AU - A. J. Carroll
AU - A. D. Carlo
AU - S. Philbin
AU - E. S. Fu
AU - J. T. Rado
AU - L. J. Rosenthal
AU - I. E. Burnett-Zeigler
AU - N. Jordan
AU - C. H. Brown
AU - J. D. Smith
A1 - 
AB - OBJECTIVE: The aim of this study was to examine disparities in treatment engagement in a pragmatic implementation trial of the collaborative care model (CoCM) for depression and anxiety. METHODS: This was a pragmatic, type 2 effectiveness-implementation, randomized rollout study of CoCM. Eleven primary care clinics were randomly assigned an intervention start date and engaged in a 1-year implementation and 1-year sustainment period. Data were extracted from electronic health records of primary care patients attending an associated clinic during the study period (October 1, 2018-January 31, 2023). Treatment engagement cascade steps were screened, referred, assessed, engaged, and completed. Logistic regression models identified demographic predictors (gender, race-ethnicity, age, and insurance status) at each step. RESULTS: A total of 117,949 primary care patients were included (59.3% were female, 78.9% were age <65, and 65.5% were White), and 59,000 patients (50.0%) were screened for CoCM. Screened patients were more likely to be Asian than White (adjusted odds ratio [AOR]=1.11) and less likely to be male (AOR=0.97), Black/African American than White (AOR=0.84), and Medicaid insured (AOR=0.80). Of 1,999 patients referred to CoCM, 469 (20% of 2,329 patients eligible for referral) were CoCM eligible; referred patients were more likely to be Black/African American than White (AOR=1.60) and less likely to be male (AOR=0.72). A total of 986 patients (49% of referred) were assessed, 882 (90% of assessed) were engaged, and 307 (35% of engaged) completed treatment; no demographic differences were observed. CONCLUSIONS: Implementation strategies are needed to increase overall and equitable reach in CoCM treatment engagement for the most vulnerable patients.
AD - Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago.; Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago.; WellBe Senior Medical, Chicago.; Department of Psychiatry, Yale School of Medicine, New Haven.; Health Sciences Integrated Ph.D. Program, Northwestern University Feinberg School of Medicine, Chicago.; Departments of Medicine and Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago.; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL.; Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, Salt Lake City.
AN - 41535737
BT - Psychiatr Serv
C5 - Healthcare Disparities
CP - 3
DA - Mar 1
DO - 10.1176/appi.ps.20240576
DP - NLM
ET - 20260115
IS - 3
JF - Psychiatr Serv
LA - eng
N2 - OBJECTIVE: The aim of this study was to examine disparities in treatment engagement in a pragmatic implementation trial of the collaborative care model (CoCM) for depression and anxiety. METHODS: This was a pragmatic, type 2 effectiveness-implementation, randomized rollout study of CoCM. Eleven primary care clinics were randomly assigned an intervention start date and engaged in a 1-year implementation and 1-year sustainment period. Data were extracted from electronic health records of primary care patients attending an associated clinic during the study period (October 1, 2018-January 31, 2023). Treatment engagement cascade steps were screened, referred, assessed, engaged, and completed. Logistic regression models identified demographic predictors (gender, race-ethnicity, age, and insurance status) at each step. RESULTS: A total of 117,949 primary care patients were included (59.3% were female, 78.9% were age <65, and 65.5% were White), and 59,000 patients (50.0%) were screened for CoCM. Screened patients were more likely to be Asian than White (adjusted odds ratio [AOR]=1.11) and less likely to be male (AOR=0.97), Black/African American than White (AOR=0.84), and Medicaid insured (AOR=0.80). Of 1,999 patients referred to CoCM, 469 (20% of 2,329 patients eligible for referral) were CoCM eligible; referred patients were more likely to be Black/African American than White (AOR=1.60) and less likely to be male (AOR=0.72). A total of 986 patients (49% of referred) were assessed, 882 (90% of assessed) were engaged, and 307 (35% of engaged) completed treatment; no demographic differences were observed. CONCLUSIONS: Implementation strategies are needed to increase overall and equitable reach in CoCM treatment engagement for the most vulnerable patients.
PY - 2026
SN - 1075-2730 (Print); 1075-2730
SP - 194
EP - 201+
ST - Disparities in the Treatment Engagement Cascade of Collaborative Care for Depression in a Pragmatic Implementation Study
T1 - Disparities in the Treatment Engagement Cascade of Collaborative Care for Depression in a Pragmatic Implementation Study
T2 - Psychiatr Serv
TI - Disparities in the Treatment Engagement Cascade of Collaborative Care for Depression in a Pragmatic Implementation Study
U1 - Healthcare Disparities
U3 - 10.1176/appi.ps.20240576
VL - 77
VO - 1075-2730 (Print); 1075-2730
Y1 - 2026
ER -