title: Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.
abstract: OBJECTIVE
  Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics.
  
  
  METHODS
  A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks.
  
  
  RESULTS
  Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (p<.001 for all). Intervention patients also had significantly improved quality-of-care indicators, including the proportion of patients receiving either psychotherapy or antidepressant medication (77% versus 21%, p<.001).
  
  
  CONCLUSIONS
  Collaborative care for depression can greatly improve care and outcomes in public-sector clinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Isabel T
authors.initials: IT
authors.lastname: Lagomasino
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Megan
authors.initials: M
authors.lastname: Dwight-Johnson
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Green
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Lingqi
authors.initials: L
authors.lastname: Tang
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Lily
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.affiliation: Dr. Lagomasino and Ms. Green are with the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles. Dr. Dwight-Johnson is with the Department of Psychiatry, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. Dr. Tang, Ms. Zhang, and Dr. Miranda are with the Center for Health Services and Society, Department of Psychiatry, University of California, Los Angeles. Dr. Duan is with the Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York City. Send correspondence to Dr. Miranda (e-mail: jmmiranda@mednet.ucla.edu ).
authors.forename: Jeanne
authors.initials: J
authors.lastname: Miranda
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000145:classification; D010549:Personal Satisfaction; D011203:Poverty; D011320:Primary Health Care; D017150:Public Sector; D058996:Quality Improvement; D011788:Quality of Life; D000068217:Social Workers
chemical_list: D000928:Antidepressive Agents
keywords: Community mental health services; Depression; Hispanics; Quality improvement