12-month outcomes of community engagement versus technical assistance to implement depression collaborative care: a partnered, cluster, randomized, comparative effectiveness trial.
12-month outcomes of community engagement versus technical assistance to implement depression collaborative care: a partnered, cluster, randomized, comparative effectiveness trial.
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DOI：
10.7326/m13-3011
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发表时间：
2014-11-18
影响因子：
39.2
通讯作者：
Wells KB
中科院分区：
文献类型：
--
作者：
Chung B;Ong M;Ettner SL;Jones F;Gilmore J;McCreary M;Sherbourne C;Ngo V;Koegel P;Tang L;Dixon E;Miranda J;Belin TR;Wells KB
在少数族裔社区使用社区参与和规划(CEP)的抑郁症协作性护理实施，与对个别项目(服务资源，RS)的技术援助相比，改善了6个月的客户结果。然而，12个月的结果是未知的。比较CEP和RS协同护理实施干预对12个月后抑郁症患者心理健康相关生活质量(MHRQL)和服务利用的影响。在随机分为CEP或RS的两个社区中，匹配的健康和社区计划(n=93)。自我报告的客户MHRQL，以及基线、6个月和12个月的服务使用情况。洛杉矶。有抑郁症状的成年人(8项患者健康问卷[PHQ-8]≥10)；85%为少数民族。CEP和RS实施抑郁症协同护理。主要结果：基线、6个月和12个月时较差的MHRQL(12项心理综合评分≤40)；次要结果：12个月的服务使用情况。在6个月时，CEP在减少较差的MHRQL方面优于RS的发现是显著的，但对潜在的统计假设敏感。同样，在12个月时，一些分析表明CEP对MHRQL有利，而其他分析没有证实有利于CEP的显著差异。CEP在6个月时减少了行为健康住院的发现在12个月时并不清楚，因为发现对潜在的统计假设很敏感。在干预12个月时，其他服务的使用没有显著差异。自我报告的数据。研究结果对建模假设很敏感。与6个月的结果相比，我们的发现没有显示出持续的CEP效应，在12个月时降低不良客户MHRQL和行为健康住院的可能性。考虑到资源不足的社区的需求，CEP的良好形象，以及缺乏基于证据的替代方案，社区参与仍然是政策制定者和社区考虑的可行战略。
Depression collaborative care implementation using community engagement and planning (CEP) across programs compared to technical assistance to individual programs (Resources for Services, RS) in minority communities improves 6-month client outcomes. However, 12-month outcomes are unknown. To compare effects of CEP and RS collaborative care implementation interventions on depressed clients’ mental health-related quality of life (MHRQL) and services use at 12-months. Matched health and community programs (n=93) in two communities randomized to CEP or RS. Self-reported client MHRQL, and services use at baseline, 6, and 12-months. Los Angeles. Adults (n=1018) with depressive symptoms (8-item Patient Health Questionnaire [PHQ-8]≥10); 85% ethnic minority. CEP and RS to implement depression collaborative care. Primary outcome: Poor MHRQL (12-item Mental Composite Score [MCS-12]≤40) at baseline, 6, and 12-months; Secondary outcomes: 12-months services use. At 6-months, the finding that CEP outperformed RS to reduce poor MHRQL was significant, but sensitive to underlying statistical assumptions. Similarly, at 12-months, some analyses suggested that CEP was advantageous on MHRQL, while other analyses did not confirm a significant difference favoring CEP. The finding that CEP reduced behavioral health hospitalizations at 6-months was not clear at 12-months with findings sensitive to underlying statistical assumptions. Other services use was not significantly different between interventions at 12-months. Self-reported data. Findings are sensitive to modeling assumptions. In contrast to 6-month results, our findings did not show consistent CEP effects on reducing the likelihood of poor client MHRQL and behavioral health hospitalizations at 12-months. Still given under-resourced communities’ needs, CEP's favorable profile, and the absence of evidence-based alternatives, community engagement remains a viable strategy for policymakers and community to consider.