Abstract
BackgroundThe purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients.MethodsCollaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience.ResultsThe clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic.ConclusionsThis project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.
Highlights
The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients
Clinics serving primarily American/Alaska Native (AI/AN) patients are interested in improvements to treat depression by implementing Collaborative Care Management
We identify quotations to support our choice of themes using a label about which staff person provided the quote (CM for Care manager and Primary Care Provider (PCP) for primary care provider)
Summary
The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. Depression often co-occurs with chronic medical conditions and substantially worsens associated health outcomes [2]. When depression is not effectively treated, it can impair self-care and participation in needed medical care, increase mortality, substantially increase overall health care costs, and decrease work productivity and economic well-being [3]. Many Native American/Alaska Native (AI/AN) communities face a high burden from the effects of depression. While rates of depression in AI/AN communities vary across communities and tribal settings [4, 5], substantial evidence with reasonable methodological rigor suggests AI/AN communities face a high burden of psychological morbidity [5]. Combined with lack of access to mental health services, depression is a major health problem that needs increased intervention and treatment [7]
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