Document Detail

Resolving disparities in antidepressant treatment and quality-of-life outcomes between uninsured and insured primary care patients with depression.
MedLine Citation:
PMID:  11502949     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Efforts to improve primary care depression treatment should penetrate to vulnerable uninsured populations. OBJECTIVE: To assess a primary care intervention's impact on treatment and quality-of-life outcomes in uninsured and insured depressed patients during the acute treatment phase. RESEARCH DESIGN: Twelve community primary care practices were randomized to 'enhanced' (intervention) and usual care conditions. Physicians, nurses and administrative staff in enhanced care practices received training to improve detection and management of depression. SUBJECTS: In 1996 to 1997, 383 nonelderly depressed patients who were either uninsured or covered by private insurance/Medicaid were enrolled; 343 (89.6%) completed six-month follow-up. MEASURES: Adequate pharmacotherapy (>or=3 months of antidepressants at therapeutic doses); adequate psychotherapy (>or=8 counseling visits); improvement in mental-health-related-quality-of-life (MHQOL), assessed by Mental Component Summary scale for SF-36. RESULTS: Multivariate results showed that 54.6% of uninsured enhanced care (UEC) patients received adequate pharmacotherapy, compared with 14.3% of uninsured usual care (UUC) patients (P = 0.0005); however, receipt of adequate psychotherapy was comparable between these two groups (18.2% UEC, 11.9% UUC; P = 0.42). Intervention effects on insured patients' treatment were modest to minimal. Among usual care patients, the insured had 5.4 points greater improvement in MHQOL at 6 months than the uninsured (12.4 points insured, 7.0 points uninsured; P = 0.02); however, among patients receiving the intervention, the insured and uninsured had comparable MHQOL improvement (12.3 points insured, 11.6 points uninsured; P = 0.76). CONCLUSIONS: The intervention improved antidepressant treatment rates in uninsured patients and helped resolve quality-of-life outcome disparities observed between insured and uninsured patients receiving usual care.
J L Smith; K M Rost; P A Nutting; C E Elliott
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  39     ISSN:  0025-7079     ISO Abbreviation:  Med Care     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-08-14     Completed Date:  2001-09-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  910-22     Citation Subset:  IM    
Center for Studies in Family Medicine, Department of Family Medicine, University of Colorado Health Sciences Center, Denver 80220, USA.
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MeSH Terms
Antidepressive Agents / therapeutic use
Chi-Square Distribution
Depressive Disorder / drug therapy,  nursing,  therapy*
Health Services Research
Medically Uninsured / statistics & numerical data*
Mental Health Services / economics,  standards*
Middle Aged
Multivariate Analysis
Outcome and Process Assessment (Health Care) / statistics & numerical data*
Primary Health Care / economics,  standards*
Quality of Life
Regression Analysis
Total Quality Management / methods*
United States
Grant Support
Reg. No./Substance:
0/Antidepressive Agents
Comment In:
Med Care. 2001 Sep;39(9):907-9   [PMID:  11502948 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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