Open AccessComparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions
Author(s) -
Benjamin Springgate,
Lingqi Tang,
Michael Ong,
Wayne Aoki,
Bowen Chung,
Elizabeth Dixon,
Megan Johnson,
Felica Jones,
Craig M. Landry,
Elizabeth Lizaola,
Norma Mtume,
Victoria K. Ngo,
Esmerelda Pulido,
Cathy D. Sherbourne,
Aziza Wright,
Yolanda Whittington,
Pluscedia Williams,
Lily Zhang,
Jeanne Miranda,
Thomas R. Belin,
James Gilmore,
Loretta Jones,
Kenneth B. Wells
Publication year - 2018
Publication title -
ethnicity and disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.767
H-Index - 67
eISSN - 1945-0826
pISSN - 1049-510X
DOI - 10.18865/ed.28.s2.325
Subject(s) - mental health , depression (economics) , medicine , patient health questionnaire , intervention (counseling) , randomized controlled trial , quality of life (healthcare) , psychiatry , gerontology , depressive symptoms , nursing , anxiety , surgery , economics , macroeconomics
Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown.Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups.Design: Secondary analyses of a cluster-randomized trial.Setting: 93 health care and community-based programs in two neighborhoods.Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys.Intervention: CEP or RS for implementing depression quality improvement programs.Outcomes and Analyses: Primary: depression (PHQ9 ≥10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by- MCC interactions (exploratory).Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC.Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.Ethn Dis. 2018;28(Suppl 2):325-338; doi:10.18865/ed.28.S2.325.