A primary care intervention for depression.
To assess a guideline-based intervention's impact on depression care provided in rural vs. urban primary care settings, 12 community primary care practices (four rural, eight urban) were randomized to enhanced (i.e., intervention) and usual care study conditions. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow-up at six months. Multilevel analytic models revealed that rural enhanced care patients had 2.70 times the odds (P = 0.02) of rural usual care patients of taking a three-month course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 times the odds compared with their urban usual care counterparts (P = 0.007). Rural enhanced care patients had 3.00 times the odds of rural usual care patients of making eight or more visits to a mental health specialist for counseling in the six months following baseline (P = 0.03). Comparisons of patients in enhanced care practices showed that rural enhanced care patients had 2.00 times the odds (P = 0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months following baseline and had comparable odds to urban enhanced care patients (odds ratio [OR] = 1.06, P = 0.77) of making eight or more visits to such specialists during that interval. The study's intervention improved the care received by both rural and urban depressed primary care patients. Moreover, the intervention's effect appears to have been greater in rural settings, particularly in terms of increasing depressed rural patients' use of mental health specialists for counseling.
Smith
J L
JL
Center for Studies in Family Medicine, University of Colorado Health Sciences Center, 1180 Clermont Street, Box B155, Denver, Colorado 80220, USA. SmithJeffreyL@exchange.uams.edu
Rost
K M
KM
Nutting
P A
PA
Elliott
C E
CE
Duan
N
N
D000328:Adult; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care; D012044:Regression Analysis; D019035:Rural Health Services; D014481:United States; D019037:Urban Health Services