title: Utilization of a mental health collaborative care model among patients who require interpreter services.
abstract: BACKGROUND
  Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice.
  
  
  METHODS
  This was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not.
  
  
  RESULTS
  Of the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]).
  
  
  CONCLUSIONS
  Within primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among patients with LEP.
authors.affiliation: Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Njeru
authors.affiliation: Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA.
authors.forename: Ramona S
authors.initials: RS
authors.lastname: DeJesus
authors.affiliation: Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: St Sauver
authors.affiliation: Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA.
authors.forename: Lila J
authors.initials: LJ
authors.lastname: Rutten
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Wilson
authors.affiliation: Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wieland
keywords: Collaborative care management; Depression; Interpreter services; Limited english proficiency; Mental health