Minority Primary Care Patients With Depression: Outcome Disparities Improve With Collaborative Care Management

Kurt B. Angstman, Sean Phelan, Mioki R. Myszkowski, Kathryn M. Schak, Ramona S. DeJesus, Timothy W. Lineberry, Michelle van Ryn

Research output: Contribution to journalArticle

Abstract

BACKGROUND/OBJECTIVES:: Racial and ethnic disparities in depression incidence, prevalence, treatment, and outcomes still persist. The hypothesis of this study was that use of collaborative care management (CCM) in treating depressed primary care patients would decrease racial disparities in 6-month clinical outcomes compared with those patients treated with usual primary care (UC).

RESEARCH DESIGN/SUBJECTS:: In a retrospective chart review analysis, 3588 (51.2%) patients received UC and 3422 (48.8%) patients were enrolled in CCM. Logistic regression analyses were used to examine disparities in 6-month outcomes.

RESULTS:: Minority patients enrolled in CCM were more likely to be participating in depression care at 6 months than minority patients in UC (61.8% vs. 14.4%; P≤0.001). After adjustment for demographic and clinical covariates, this difference remained statistically significant (odds ratio=9.929; 95% CI, 6.539–15.077, P≤0.001).The 568 minority UC patients with 6-month follow-up PHQ-9 data demonstrated a much lower odds ratio of a PHQ-9 score of <5 (0.220; 95% CI, 0.085–0.570; P=0.002) and a much higher odds ratio of PHQ-9 score of ≥10 (3.068; 95% CI, 1.622–5.804; P<0.001) when compared with the white, non-Hispanic patients. In contrast, the 2329 patients treated with CCM, the odds ratio for a PHQ-9 score of <5 or ≥10 after 6 months, demonstrated no significance of minority status.

CONCLUSIONS:: Utilization of CCM for depression was associated with a significant reduction of the disparities for outcomes of compliance, remission, or persistence of depressive symptoms for minority patients with depression versus those treated with UC.

Original languageEnglish (US)
JournalMedical Care
DOIs
StateAccepted/In press - Nov 27 2014
Externally publishedYes

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Primary Health Care
Odds Ratio
Depression
Compliance
Research Design
Logistic Models
Regression Analysis
Demography
Incidence

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Angstman, K. B., Phelan, S., Myszkowski, M. R., Schak, K. M., DeJesus, R. S., Lineberry, T. W., & van Ryn, M. (Accepted/In press). Minority Primary Care Patients With Depression: Outcome Disparities Improve With Collaborative Care Management. Medical Care. https://doi.org/10.1097/MLR.0000000000000280

Minority Primary Care Patients With Depression : Outcome Disparities Improve With Collaborative Care Management. / Angstman, Kurt B.; Phelan, Sean; Myszkowski, Mioki R.; Schak, Kathryn M.; DeJesus, Ramona S.; Lineberry, Timothy W.; van Ryn, Michelle.

In: Medical Care, 27.11.2014.

Research output: Contribution to journalArticle

Angstman, Kurt B. ; Phelan, Sean ; Myszkowski, Mioki R. ; Schak, Kathryn M. ; DeJesus, Ramona S. ; Lineberry, Timothy W. ; van Ryn, Michelle. / Minority Primary Care Patients With Depression : Outcome Disparities Improve With Collaborative Care Management. In: Medical Care. 2014.
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abstract = "BACKGROUND/OBJECTIVES:: Racial and ethnic disparities in depression incidence, prevalence, treatment, and outcomes still persist. The hypothesis of this study was that use of collaborative care management (CCM) in treating depressed primary care patients would decrease racial disparities in 6-month clinical outcomes compared with those patients treated with usual primary care (UC).RESEARCH DESIGN/SUBJECTS:: In a retrospective chart review analysis, 3588 (51.2{\%}) patients received UC and 3422 (48.8{\%}) patients were enrolled in CCM. Logistic regression analyses were used to examine disparities in 6-month outcomes.RESULTS:: Minority patients enrolled in CCM were more likely to be participating in depression care at 6 months than minority patients in UC (61.8{\%} vs. 14.4{\%}; P≤0.001). After adjustment for demographic and clinical covariates, this difference remained statistically significant (odds ratio=9.929; 95{\%} CI, 6.539–15.077, P≤0.001).The 568 minority UC patients with 6-month follow-up PHQ-9 data demonstrated a much lower odds ratio of a PHQ-9 score of <5 (0.220; 95{\%} CI, 0.085–0.570; P=0.002) and a much higher odds ratio of PHQ-9 score of ≥10 (3.068; 95{\%} CI, 1.622–5.804; P<0.001) when compared with the white, non-Hispanic patients. In contrast, the 2329 patients treated with CCM, the odds ratio for a PHQ-9 score of <5 or ≥10 after 6 months, demonstrated no significance of minority status.CONCLUSIONS:: Utilization of CCM for depression was associated with a significant reduction of the disparities for outcomes of compliance, remission, or persistence of depressive symptoms for minority patients with depression versus those treated with UC.",
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AU - DeJesus, Ramona S.

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AB - BACKGROUND/OBJECTIVES:: Racial and ethnic disparities in depression incidence, prevalence, treatment, and outcomes still persist. The hypothesis of this study was that use of collaborative care management (CCM) in treating depressed primary care patients would decrease racial disparities in 6-month clinical outcomes compared with those patients treated with usual primary care (UC).RESEARCH DESIGN/SUBJECTS:: In a retrospective chart review analysis, 3588 (51.2%) patients received UC and 3422 (48.8%) patients were enrolled in CCM. Logistic regression analyses were used to examine disparities in 6-month outcomes.RESULTS:: Minority patients enrolled in CCM were more likely to be participating in depression care at 6 months than minority patients in UC (61.8% vs. 14.4%; P≤0.001). After adjustment for demographic and clinical covariates, this difference remained statistically significant (odds ratio=9.929; 95% CI, 6.539–15.077, P≤0.001).The 568 minority UC patients with 6-month follow-up PHQ-9 data demonstrated a much lower odds ratio of a PHQ-9 score of <5 (0.220; 95% CI, 0.085–0.570; P=0.002) and a much higher odds ratio of PHQ-9 score of ≥10 (3.068; 95% CI, 1.622–5.804; P<0.001) when compared with the white, non-Hispanic patients. In contrast, the 2329 patients treated with CCM, the odds ratio for a PHQ-9 score of <5 or ≥10 after 6 months, demonstrated no significance of minority status.CONCLUSIONS:: Utilization of CCM for depression was associated with a significant reduction of the disparities for outcomes of compliance, remission, or persistence of depressive symptoms for minority patients with depression versus those treated with UC.

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