Telemedicine-Based Collaborative Care Intervention for Depression has Greater Effect on Minority vs. White Veterans
BACKGROUND:
Recent data suggest that among depressed adults, treatment seeking is significantly lower for African-Americans and Hispanics than for Caucasians, and that the majority of persons from minority groups seek help for depression in primary care settings. In addition to low rates of treatment seeking, African Americans are less likely than Caucasians to receive guideline-concordant depression care in primary care settings. Efforts to improve the quality of depression care for minority populations have largely focused on collaborative care approaches, but few studies have examined potential factors contributing to minority patients' improved responses to collaborative care interventions. The Telemedicine Enhanced Antidepressant Management (TEAM) study was a randomized trial of telemedicine-based collaborative care tailored for small, rural primary care practices. Investigators in this study evaluated racial differences in clinical outcomes among 360 Veterans with depression (272 in Caucasian group, 88 in minority group), who were randomized to usual care or the TEAM intervention between 4/03 and 9/04. Veterans in the intervention received a stepped-care model of depression treatment for up to 12 months, which included an onsite primary care team and an offsite depression care team. Investigators estimated the specific treatment effects separately for the minority group and the Caucasian group, and also looked at prior depression treatment and perceived barriers.
FINDINGS:
- In the usual care group, minority Veterans had a lower treatment response rate (8%) than Caucasians (18%), but this was not significant. In contrast, minority Veterans in the TEAM intervention group had a significantly higher treatment response rate (42%) than Caucasians (19%) in the intervention group.
- Veterans in the minority group were significantly less likely to report that antidepressants were an acceptable form of treatment, and were significantly less likely to have had prior or current depression treatment. However, none of these variables were significantly related to treatment outcomes. Thus, the study was not able to determine why minorities responded better to the intervention than Caucasians.
LIMITATIONS:
- Due to inadequate sample sizes, different minority groups (i.e., African Americans, Hispanics) were combined into one group, which may have over-simplified findings.
AUTHOR/FUNDING INFORMATION:
This study was funded through HSR&D (IIR 00-078) and the VA South Central Mental Illness Research Education and Clinical Center (MIRECC). Drs. Davis, Deen, and Fortney are part of MIRECC. Dr. Fortney also is part of HSR&D's Center for Mental Healthcare and Outcomes Research in Little Rock, AR.
Davis T, Deen T, Bryant-Bedell K, Tate V, and Fortney J. Does Minority Group Status Moderate Outcomes of Collaborative Care for Depression? Psychiatric Services November 2011;62(11):1282-88.
