Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial

Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adop...

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Bibliographic Details
Published in:Journal of medical Internet research 2018-04, Vol.20 (4), p.e147-e147
Main Authors: Wu, Shinyi, Ell, Kathleen, Jin, Haomiao, Vidyanti, Irene, Chou, Chih-Ping, Lee, Pey-Jiuan, Gross-Schulman, Sandra, Sklaroff, Laura Myerchin, Belson, David, Nezu, Arthur M, Hay, Joel, Wang, Chien-Ju, Scheib, Geoffrey, Di Capua, Paul, Hawkins, Caitlin, Liu, Pai, Ramirez, Magaly, Wu, Brian W, Richman, Mark, Myers, Caitlin, Agustines, Davin, Dasher, Robert, Kopelowicz, Alex, Allevato, Joseph, Roybal, Mike, Ipp, Eli, Haider, Uzma, Graham, Sharon, Mahabadi, Vahid, Guterman, Jeffrey
Format: Article
Language:English
Subjects:
Bias
Cholesterol
Clinical assessment
Clinical outcomes
Clinical research
Clinical trials
Collaboration
Communications technology
Comorbidity
Diabetes
Disability
Emotional disturbances
Health care management
Health disparities
Health promotion
Health services
Hemoglobin
Information technology
Mental depression
Original Paper
Patient satisfaction
Patients
Primary care
Propensity
Quality of care
Quasi-experimental methods
Questionnaires
Remission (Medicine)
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Summary:Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supp
ISSN:1438-8871
1439-4456
1438-8871
DOI:10.2196/jmir.7692