title: Impact of ongoing primary care intervention on long term outcomes in uninsured and insured patients with depression.
abstract: OBJECTIVE
  To assess the differential impact of an ongoing primary care depression intervention on uninsured and insured patients' outcomes 12, 18, and 24 months following baseline.
  
  
  METHODS
  Quasi-experimental longitudinal study of insured and uninsured patients with depression receiving treatment from 12 practices randomized to enhanced (intervention) and usual care study conditions.
  
  
  METHODS
  In 1996 to 1997, 383 nonelderly patients with depression (290 insured, 93 uninsured) were enrolled and followed for 24 months.
  
  
  METHODS
  Mental-health-related-quality-of-life (MHQOL) was assessed at each follow-up using the SF-36 Mental Component Summary scale. Presence of major depressive episode was assessed at 24-month follow-up with the Composite International Diagnostic Interview.
  
  
  RESULTS
  Uninsured enhanced-care patients had significantly better MHQOL outcomes at 24 months than uninsured usual care patients (40.6 vs. 32.7, respectively; P = 0.01). The intervention had no significant impact on insured patients' MHQOL outcomes at any follow-up interval. Among patients receiving usual care, the uninsured compared with the insured had significantly poorer MHQOL outcomes (32.7 vs. 40.7, respectively; P = 0.002) and significantly increased probability of experiencing a major depressive episode (40.6% vs. 19.8%, respectively; P = 0.04) at 24 months. No such disparities were observed between uninsured and insured patients receiving enhanced care.
  
  
  CONCLUSIONS
  The ongoing intervention significantly improved quality-of-life outcomes in uninsured patients at 24 months. If the intervention's impact on MHQOL can be confirmed and proved cost-effective in larger uninsured patient populations, clinicians serving the uninsured may want to consider implementing the study's intervention.
authors.affiliation: Department of Family Medicine, University of Colorado Health Sciences Center, PO Box 6508, 12474 E. 19th Avenue, Building 402, Aurora, CO 80045-0508, USA. Jeff.Smith@uchsc.edu
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Smith
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rost
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.forename: Carl E
authors.initials: CE
authors.lastname: Elliott
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D017057:Medically Uninsured; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life