Does Minority Racial-Ethnic Status Moderate Outcomes of Collaborative Care for Depression?
Does Minority Racial-Ethnic Status Moderate Outcomes of Collaborative Care for Depression?
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DOI：
10.1176/ps.62.11.pss6211_1282
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发表时间：
2011-11-01
影响因子：
3.8
通讯作者：
Fortney, John
中科院分区：
文献类型：
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作者：
Davis, Teri D.;Deen, Tisha;Fortney, John
目的：作者对在退伍军人事务部社区初级保健诊所治疗抑郁症的360名退伍军人进行了一项涉及协作护理和常规护理的干预措施的反应率的种族差异进行了研究。方法：抑郁症筛查呈阳性的个体被随机分配到常规护理组（N=200）或协作护理干预组（N=160），该干预组在必要时与注册护士和临床药剂师进行电话联系，以解决与药物依从性和副作用管理有关的问题，并通过与协作护理小组的视频聊天由精神科医生进行监督。在基线和6个月后通过电话收集有关患者特征、治疗史和治疗反应的数据。结果：退伍军人中白人占75% (N=272)，少数族裔占25% (N=88)，其中非裔美国人占18% (N=64)，印第安人占3% (N=11)，其他少数族裔占3.6% （N=13）。白种人和少数族裔对常规护理的反应率无显著差异（分别为18%和8%），但少数族裔对干预的反应率（42%）高于白种人（19%）（chi(2)=8.2, df=1, p= 0.004）。回归分析表明，即使校正了与少数群体身份相关的其他因素（OR=6.0, 95% CI=1.5-24.3, p= 0.01），干预与少数群体身份的相互作用也能显著预测疗效（比值比[OR]=6.2, 95%置信区间[CI]=1.6-24.5, p= 0.009）。结论：忧郁症治疗中的种族差异可以通过合作治疗方案得到改善。（精神科服务62:1282-1288,2011）
Objective: The authors examined racial differences in response rates to an intervention involving collaborative care and usual care among 360 veterans treated for depression at Department of Veterans Affairs community-based primary care clinics. Methods: Individuals who screened positive for depression were assigned randomly to usual care (N=200) or to a collaborative care intervention (N=160) that provided phone contact when necessary with a registered nurse and clinical pharmacist to address issues related to compliance with medication and side effect management as well as supervision by a psychiatrist through video chats with the collaborative care team. Data about patients' characteristics, treatment history, and response to treatment were collected by telephone at baseline and after six months. Results: Seventy-five percent (N=272) of the veterans were Caucasian, and 25% (N=88) belonged to a minority group, including 18% (N=64) who were African American, 3% (N=11) who were Native American, and 3.6% (N=13) who were of other minority groups. There were no significant differences between response rates between the Caucasian and minority group to usual care (18% and 8%, respectively), but the minority group had a higher response rate (42%) than Caucasians (19%) to the intervention (chi(2)=8.2, df=1, p=.004). Regression analysis indicated that the interaction of minority group status by intervention significantly predicted response (odds ratio [OR]=6.2, 95% confidence interval [CI]=1.6-24.5, p=.009), even after adjustment for other factors associated with minority status (OR=6.0, 95% CI=1.5-24.3, p=.01). Conclusions: Racial disparities in depression care may be ameliorated through collaborative care programs. (Psychiatric Services 62:1282-1288, 2011)