Comparative effectiveness of standard versus patient-centered collaborative care interventions for depression among African Americans in primary care settings: the BRIDGE Study.
OBJECTIVE
To compare the effectiveness of standard and patient-centered, culturally tailored collaborative care (CC) interventions for African American patients with major depressive disorder (MDD) over 12 months of follow-up.


METHODS
Twenty-seven primary care clinicians and 132 African American patients with MDD in urban community-based practices in Maryland and Delaware.


METHODS
Cluster randomized trial with patient-level, intent-to-treat analyses.


METHODS
Patients completed screener and baseline, 6-, 12-, and 18-month interviews to assess depression severity, mental health functioning, health service utilization, and patient ratings of care.


RESULTS
Patients in both interventions showed statistically significant improvements over 12 months. Compared with standard, patient-centered CC patients had similar reductions in depression symptom levels (-2.41 points; 95 percent confidence interval (CI), -7.7, 2.9), improvement in mental health functioning scores (+3.0 points; 95 percent CI, -2.2, 8.3), and odds of rating their clinician as participatory (OR, 1.48, 95 percent CI, 0.53, 4.17). Treatment rates increased among standard (OR = 1.8, 95 percent CI 1.0, 3.2), but not patient-centered (OR = 1.0, 95 percent CI 0.6, 1.8) CC patients. However, patient-centered CC patients rated their care manager as more helpful at identifying their concerns (OR, 3.00; 95 percent CI, 1.23, 7.30) and helping them adhere to treatment (OR, 2.60; 95 percent CI, 1.11, 6.08).


CONCLUSIONS
Patient-centered and standard CC approaches to depression care showed similar improvements in clinical outcomes for African Americans with depression; standard CC resulted in higher rates of treatment, and patient-centered CC resulted in better ratings of care.
Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. lisa.cooper@jhmi.edu
Lisa A
LA
Cooper
Bri K
BK
Ghods Dinoso
Daniel E
DE
Ford
Debra L
DL
Roter
Annelle B
AB
Primm
Susan M
SM
Larson
James M
JM
Gill
Gary J
GJ
Noronha
Elias K
EK
Shaya
Nae-Yuh
NY
Wang
D000328:Adult; D001741:Black or African American; D003142:Communication; D057186:Comparative Effectiveness Research; D054521:Cultural Competency; D003865:Major Depressive Disorder / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000208:ethnology; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors