Are patient characteristics associated with quality of depression care and outcomes in collaborative care programs for depression?
OBJECTIVE
To determine whether demographic or clinical characteristics of primary care patients are associated with depression treatment quality and outcomes within a collaborative care model.


METHODS
Collaborative depression care, based on principles from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, was implemented in six community health organizations serving disadvantaged patients. Over 3 years, 2821 patients were treated. Outcomes were receipt of quality treatment and depression improvement.


RESULTS
Logistic regression analyses revealed that patients who were older, more depressed or more anxious were more likely to be retained in treatment and to receive appropriate pharmacotherapy. Whereas gender and depression severity were unrelated to depression outcomes, significantly more patients who preferred Spanish (59.1%) than English (48.5%, P<.01) improved within 12 weeks in multivariate analyses. High baseline anxiety was associated with a lower probability of improvement, and older age showed a similar trend. Survival analyses demonstrated that patients who preferred Spanish or were less anxious improved significantly more rapidly than their counterparts (P<.001).


CONCLUSIONS
Patients with more anxiety received higher quality care but experienced worse depression outcomes than less anxious patients. Spanish language preference was strongly associated with depression improvement. This collaborative care program attained admirable outcomes among disadvantaged Spanish-speaking patients without extensive cultural tailoring of care.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA. abauer1@u.washington.edu
Amy M
AM
Bauer
Vanessa
V
Azzone
Laurie
L
Alexander
Howard H
HH
Goldman
Jürgen
J
Unützer
Richard G
RG
Frank
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003863:Depression / Q000628:therapy*; D019468:Disease Management; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010361:Patients; D011787:Quality of Health Care; D012044:Regression Analysis; D055815:Young Adult