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BMC Health Services Research

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01-12-2020 | Mood Disorders | Research article

Implementing collaborative care to reduce depression for rural native American/Alaska native people

Authors: Deborah J. Bowen, Diane M. Powers, Joan Russo, Robert Arao, Erin LePoire, Earl Sutherland, Anna D. H. Ratzliff

Published in: BMC Health Services Research | Issue 1/2020

Abstract

Background

The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients.

Methods

Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience.

Results

The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic.

Conclusions

This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.

Global Burden of Disease (GBD). Institute for Health Metrics and Evaluation. http://www.healthdata.org/node/835. Published December 17, 2018. Accessed 11 Jan 2019.

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. CC for depression and anxiety problems. Cochrane Database Syst Rev. 2012;10:CD006525. https://doi.org/10.1002/14651858.CD006525.pub2.CrossRefPubMed

Chisholm D, Sanderson K, Ayuso-Mateos JL, Saxena S. Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions. Br J Psychiatry. 2004;184(5):393–403. https://doi.org/10.1192/bjp.184.5.393.CrossRefPubMed

Beals J, Manson SM, Whitesell NR, Mitchell CM, Novins DK, Simpson S, Spicer P. Prevalence of major depressive episode in two American Indian reservation populations: unexpected findings with a structured interview. Am J Psychiatry. 2005;162(9):1713–22.CrossRef

Asdigian NL, Bear UR, Beals J, Manson SM, Kaufman CE. Mental health burden in a national sample of American Indian and Alaska native adults: differences between multiple-race and single-race subgroups. Soc Psychiatry Psychiatr Epidemiol. 2018;53(5):521–30. https://doi.org/10.1007/s00127-018-1494-1 Epub 2018 Feb 22.CrossRefPubMed

Bird SR, Held S, McCormick A, Hallett J, Martin C, Trottier C. The Impact of Historical and Current Loss on Chronic Illness: Perceptions of Crow (Apsáalooke) People. Int J Indig Health. 2016;11(1):198–210. https://doi.org/10.18357/ijih111201614993.CrossRefPubMedPubMedCentral

Reschovsky JD, Staiti AB. Access and quality: does rural America lag behind? Health Aff. 2005;24(4):1128–39.CrossRef

Burke BT, Miller BF, Proser M, et al. A needs-based method for estimating the behavioral health staff needs of community health centers. BMC Health Serv Res. 2013;13:245. Published 2013 Jul 2. https://doi.org/10.1186/1472-6963-13-245.CrossRefPubMedPubMedCentral

What is a Federally Qualified Health Center (FQHC)? FQHC Germane. https://www.fqhc.org/what-is-an-fqhc/. Accessed 11 Jan 2019.

10.

Ellis AR, Konrad TR, Thomas KC, Morrissey JP. County-level estimates of mental health professional supply in the United States. Psychiatr Serv. 2009;60(10):1315–22. https://doi.org/10.1176/ps.2009.60.10.1315.CrossRefPubMed

11.

Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA. National trends in the outpatient treatment of depression. JAMA. 2002;287(2):203–9.CrossRef

12.

Institute of Medicine (US) Committee on Quality of Health Care in America. In: Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington DC: National Academies Press (US); 2000. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225182/. https://doi.org/10.17226/9728.CrossRef

13.

Druss BG, Bornemann T, Fry-Johnson YW, McCombs HG, Politzer RM, Rust G. Trends in mental health and substance abuse Services at the Nation’s community health centers: 1998–2003. Am J Public Health. 2006;96(10):1779–84. https://doi.org/10.2105/AJPH.2005.076943.CrossRefPubMedPubMedCentral

14.

Rosenblatt A, Compian L. Exchanging Glances? Systems, Practice, and Evidence in Children's Mental Health Services. In: Fisher WH, editor. Research on Community-Based Mental Health Services for Children and Adolescents (Research in Community and Mental Health, Volume 14). Washington DC:: Emerald Group Publishing Limited; 2006. p. 201–37.

15.

Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C. Quality improvement in chronic illness care: a collaborative approach. J Qual Improv. 2001;27(2):63–80.CrossRef

16.

Unutzer J, Katon W, Callahan CM, Williams JW, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noel PH, Lin EH, Arean PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836–45.CrossRef

17.

Thota AB, Sipe TA, Byard GJ, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med. 2012;42(5):525–38. https://doi.org/10.1016/j.amepre.2012.01.019.CrossRefPubMed

18.

Bower P, Gilbody S, Richards D, Fletcher J, Sutton A. Collaborative care for depression in primary care-making sense of a complex intervention: systematic review and meta regression. Br J Psychiatry. 2006;189:484–93.CrossRef

19.

Urban Indian Health Institute, Seattle Indian Health Board. Addressing depression among American Indians and Alaska natives: a literature review. Seattle: Urban Indian Health Institute; 2012.

20.

U.S. Department of Health and Human Services Indian Health Service Division of Behavioral Health Office of Clinical and Preventive Services August 2011.

21.

Lewis ME, Myhra LL. Integrated care with indigenous populations: a systematic review of the literature. Am Indian and Alsk Native Ment Health Res. 2017;24(3):88–110. https://doi.org/10.5820/aian.2403.2017.88.CrossRef

22.

Powers DM, Bowen DJ, Arao R, Vredevoogd M, Russo J, Grover T, Unützer J. Collaborative Care for Depression: US Rural Primary Care Outcomes. Families, Systems and Health (in press).

23.

Powers DM, Bowen DJ, Ratzliff A, Grover T, Unutzer J. Improving rural primary care depression treatment: Intervention, implementation, and evaluation design. Families, Systems and Health (in press).

24.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRef

25.

Rossom RC, Solberg LI, Magnan S, et al. Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. Gen Hosp Psychiatry. 2017;44:77–85. https://doi.org/10.1016/j.genhosppsych.2016.05.006.CrossRefPubMed

26.

Unutzer J, Choi Y, Cook IA, Oishi S. A web-based data management system to improve care for depression in a multicenter clinical trial. Psychiatr Serv. 2002;53(6):671–673, 678.CrossRef

27.

Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health Questionnaire-9. Med Care. 2004;42(12):1194–201.CrossRef

28.

Simon GE, Rutter CM, Peterson D, et al. Does response on the PHQ-9 depression questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv. 2013;64(12):1195–202. https://doi.org/10.1176/appi.ps.201200587.CrossRefPubMedPubMedCentral

29.

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. https://doi.org/10.1136/bmj.g1687.CrossRefPubMed

30.

Huria T, Palmer SC, Pitama S, Beckert L, Lacey C, Ewen S, Smith L. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol. 2019;19(1):173.CrossRef

Title: Implementing collaborative care to reduce depression for rural native American/Alaska native people
Authors: Deborah J. Bowen
Diane M. Powers
Joan Russo
Robert Arao
Erin LePoire
Earl Sutherland
Anna D. H. Ratzliff
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Mood Disorders
Care
Affective Disorder
Published in: BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-019-4875-6

At a glance: The STEP trials

Springer Medicine

Implementing collaborative care to reduce depression for rural native American/Alaska native people

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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