Journal Article

Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities

Wells, Kenneth B., Tang, Lingqi, Sherbourne, Cathy, Chung, Bowen, Ramos, Esmeralda, Belin, Thomas R., Miranda, Jeanne, Gilmore, Jim, Ngo, Victoria K., Jones, Loretta, Ong, Michael K., Stockdale, Susan, Dixon, Elizabeth L.

2013

Overview

ABSTRACT BACKGROUND Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. OBJECTIVE To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients’ mental health-related quality of life (HRQL) and services use. DESIGN Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. PARTICIPANTS From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. MEASURES Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. RESULTS CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p  < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p  > 0.05). CONCLUSION Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.

• Publisher: Springer US,Springer,Springer Nature B.V
• Subject: Adult / Adult and adolescent clinical studies / Biological and medical sciences / Community Mental Health Services - organization & administration / Community Mental Health Services - standards / Community Mental Health Services - utilization / Community service / Comparative Effectiveness Research - methods / Cooperative Behavior / Depression / Depression - therapy / Depressive Disorder - therapy / Female / General aspects / Health care access / Health Care Reform - methods / Health Planning - organization & administration / Health Services - utilization / Health Services Needs and Demand / Health Services Research - methods / Healthcare Disparities / Hospitalization - statistics & numerical data / Humans / Interinstitutional Relations / Internal Medicine / Los Angeles / Male / Medical sciences / Medically Underserved Area / Medicine / Medicine & Public Health / Mental depression / Middle Aged / Minority & ethnic groups / Miscellaneous / Mood disorders / Original Research / Patient Selection / Psychiatric Status Rating Scales / Psychology. Psychoanalysis. Psychiatry / Psychopathology. Psychiatry / Quality of Life / Single-Blind Method / Socioeconomic Factors / Treatment Outcome