Effectiveness of collaborative care in addressing depression treatment preferences among low-income Latinos.
OBJECTIVE
This study assessed treatment preferences among low-income Latino patients in public-sector primary care clinics and examined whether a collaborative care intervention that included patient education and allowed patients to choose between medication, therapy, or both would increase the likelihood that patients received preferred treatment.


METHODS
A total of 339 Latino patients with probable depressive disorders were recruited; participants completed a baseline conjoint analysis preference survey and were randomly assigned to receive the intervention or enhanced usual care. At 16 weeks, a patient survey assessed depression treatment received during the study period. Logistic regression models were constructed to estimate treatment preferences, examine patient characteristics associated with treatment preferences, and examine patient characteristics associated with a match between stated preference and actual treatment received.


RESULTS
The conjoint analysis preference survey showed that patients preferred counseling or counseling plus medication over antidepressant medication alone and that they preferred treatment in primary care over specialty mental health care, but they showed no significant preference for individual versus group treatment. Patients also indicated that individual education sessions, telephone sessions, transportation assistance, and family involvement were barrier reduction strategies that would enhance their likelihood of accepting treatment. Compared with patients assigned to usual care, those in the intervention group were 21 times as likely to receive preferred treatment. Among all participants, women, unemployed persons, those who spoke English, and those referred by providers were more likely to receive preferred treatment.


CONCLUSIONS
Collaborative care interventions that include psychotherapy can increase the likelihood that Latino patients receive preferred care; however, special efforts may be needed to address preferences of working persons, men, and Spanish-speaking patients.
RAND Corporation, 1776 Main St., Santa Monica, CA 90401, USA. meganj@rand.org
Megan
M
Dwight-Johnson
Isabel T
IT
Lagomasino
Joel
J
Hay
Lily
L
Zhang
Lingqi
L
Tang
Jennifer M
JM
Green
Naihua
N
Duan
D000928:Antidepressive Agents / Q000627:therapeutic use; D003376:Counseling; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D003866:Depressive Disorder / Q000188:drug therapy / Q000208:ethnology / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D011203:Poverty / Q000523:psychology; D012959:Socioeconomic Factors
D000928:Antidepressive Agents