Differential effectiveness of depression disease management for rural and urban primary care patients.
BACKGROUND
Federally qualified health centers across the country are adopting depression disease management programs following federally mandated training; however, little is known about the relative effectiveness of depression disease management in rural versus urban patient populations.


OBJECTIVE
To explore whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling).


METHODS
A preplanned secondary analysis was conducted in a consecutively sampled cohort of 479 depressed primary care patients recruited from 12 practices in 10 states across the country participating in the Quality Enhancement for Strategic Teaming study.


RESULTS
Depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.


CONCLUSIONS
Depression disease management appears to improve clinical outcomes in urban but not rural patients. Because these programs compete for scarce resources, health care organizations interested in delivering depression disease management to rural populations need to advocate for programs whose clinical effectiveness has been demonstrated for rural residents.
Adams
Scott J
SJ
Western Interstate Commission for Higher Education (WICHE) Mental Health Program, Boulder, CO 80301-9752, USA. sadams@wiche.edu
Xu
Stanley
S
Dong
Fran
F
Fortney
John
J
Rost
Kathryn
K
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003376:Counseling; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D016896:Treatment Outcome; D019037:Urban Health Services / Q000458:organization & administration*
D000928:Antidepressive Agents