Comparative Effectiveness of Standard versus Patient‐Centered Collaborative Care Interventions for Depression among African Americans in Primary Care Settings: The BRIDGE Study. (20th June 2012)

• Record Type: Journal Article
• Authors: Cooper, Lisa A.; Ghods Dinoso, Bri K.; Ford, Daniel E.; Roter, Debra L.; Primm, Annelle B.; Larson, Susan M.; Gill, James M.; Noronha, Gary J.; Shaya, Elias K.; Wang, Nae‐Yuh
• Is Part Of: Health services research. Volume 48:Number 1(2013:Feb.)
• Page Start: 150
• Page End: 174
• Publication Date: 2012-06-20
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/j.1475-6773.2012.01435.x
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" xml:lang="en" id="hesr1435-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr1435-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare the effectiveness of standard and patient‐centered, culturally tailored collaborative care (CC) interventions for African American patients with major depressive disorder (MDD) over 12 months of follow‐up.</p> </sec> <sec id="hesr1435-sec-0002" sec-type="section"> <title>Data Sources/Study Setting</title> <p>Twenty‐seven primary care clinicians and 132 African American patients with MDD in urban community‐based practices in Maryland and Delaware.</p> </sec> <sec id="hesr1435-sec-0003" sec-type="section"> <title>Study Design</title> <p>Cluster randomized trial with patient‐level, intent‐to‐treat analyses.</p> </sec> <sec id="hesr1435-sec-0004" sec-type="section"> <title>Data Collection/Extraction Methods</title> <p>Patients completed screener and baseline, 6‐, 12‐, and 18‐month interviews to assess depression severity, mental health functioning, health service utilization, and patient ratings of care.</p> </sec> <sec id="hesr1435-sec-0005" sec-type="section"> <title>Principal Findings</title> <p>Patients in both interventions showed statistically significant improvements over 12 months. Compared with standard, patient‐centered CC patients had similar reductions in depression symptom levels (−2.41 points; 95 percent confidence interval (CI), −7.7, 2.9), improvement in mental health functioning scores (+3.0 points; 95 percent CI, −2.2, 8.3), and odds of rating their clinician as participatory (OR, 1.48, 95 percent CI, 0.53, 4.17). Treatment rates increased among standard (OR = 1.8, 95 percent CI 1.0, 3.2), but not patient‐centered (OR = 1.0, 95 percent CI 0.6, 1.8) CC patients. However, patient‐centered CC patients rated their care manager as more helpful at identifying their concerns (OR, 3.00; 95 percent CI, 1.23, 7.30) and helping them adhere to treatment (OR, 2.60; 95 percent CI, 1.11, 6.08).</p> </sec> <sec id="hesr1435-sec-0006" sec-type="section"> <title>Conclusions</title> <p>Patient‐centered and standard CC approaches to depression care showed similar improvements in clinical outcomes for African Americans with depression; standard CC resulted in higher rates of treatment, and patient‐centered CC resulted in better ratings of care.</p> </sec> </abstract>