Integration of Mental Health Services Into Primary Care Overcomes Ethnic Disparities in Access to Mental Health Services Between Black and White Elderly

Ayalon, Liat; Areán, Patricia A.; Linkins, Karen W.; Lynch, Marty; Estes, Carroll L.

doi:10.1097/jgp.0b013e318135113e

Cited by 77 publications

(44 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These fi ndings are aligned with recent fi ndings that older primary care patients are more likely to be engaged in integrated care than other forms of care provision, 44 and integrated care models are particularly effective in improving access to and participation in mental health services among African American primary care patients. 45 Many large-scale, randomized controlled trials using complex, multimodel, care management interventions have been successful in improving depression outcomes, 43,46 but they have not integrated depression treatment with chronic medical conditions. We sought to evaluate the effectiveness of a relatively brief, pilot, randomized controlled trial with a focus on adherence for the management of depression, as well as hypertension, in primary care.…”

Section: Discussionmentioning

confidence: 99%

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Bogner¹,

Vries²

2008

The Annals of Family Medicine

120

122

View full text Add to dashboard Cite

PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications, depression outcomes, and blood pressure control among older primary care patients. METHODSOlder adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence. RESULTSIn all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.CONCLUSION A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources. Ann Fam Med 2008;6:295-301. DOI: 10.1370/afm.843. INTRODUCTIONP rimary care occupies a strategic position in the evaluation and treatment of depression among older adults, 1 and enhancing depression management in primary care appears to be a promising use of health care resources.2 To have an impact on public health, advances in the treatment of depression must be realized in primary care. Although recent studies have shown that a variety of primary care interventions can improve depression outcomes among older adults, 3,4 these interventions are not being widely implemented in practice. Some evidence indicates that addressing medical comorbidity, especially cardiovascular disease (CVD), may be essential in managing depression. [5][6][7] In addition, managing depression in the context of medical comorbidity may be more acceptable to patients than managing depression alone. DEPR ES SION A ND HY PER T ENSION T R E AT MEN Tmanagement of depression with management of medical comorbidity.In this trial, we focused on integrating depression management into care for hypertension. Hypertension affects between 20% to 50% of adults in most countries 9 and is a major risk factor for cardiovascular morbidity and mortality, 10 representing two-thirds of all s...

show abstract

Section: Discussionmentioning

confidence: 99%

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Bogner¹,

Vries²

2008

The Annals of Family Medicine

120

122

View full text Add to dashboard Cite

show abstract

“…With respect to individual-level factors, Andersen's model suggests that help-seeking is determined by predisposing variables such as age and gender, enabling resources such as social support, and objective and subjective indicators of need for help. Research examining the influence of predisposing and enabling characteristics on older adults' help-seeking suggests that lower levels of service use are associated with older age (16), ethnic minority status (17), and poor mental health literacy (18). In contrast, stigma does not appear to be a significant barrier to older adults' use of services (19, 20).…”

Section: Introductionmentioning

confidence: 99%

Correlates of Perceived Need for and Use of Mental Health Services by Older Adults in the Collaborative Psychiatric Epidemiology Surveys

Mackenzie

Pagura

Sareen

2010

The American Journal of Geriatric Psychiatry

157

109

View full text Add to dashboard Cite

Objectives Older adults are especially unlikely to seek mental health services, but little is known about whether their perceptions of need for help contribute to this problem. The objectives of this study were to compare perceived need across the lifespan and to examine sociodemographic and mental health correlates of whether or not older adults sought professional help, perceived the need for help without seeking it, and sought help from specialty mental health professionals. Methods The authors examined help-seeking and perceived need with the Collaborative Psychiatric Epidemiology Surveys, focusing on 3,017 adults 55 years of age and older. Logistic regressions predicted help-seeking and perceived need from sociodemographic factors, past-year psychiatric disorders, and past-year suicidal behaviors. Individuals who perceived the need for help without receiving it also reported barriers to help-seeking. Results Levels of perceived need were highest among 25-44 year-olds and lowest among adults 65 years of age and older. Among older adults with psychiatric disorders, 47.1% did not perceive a need for professional help. Diagnoses and suicidal behaviors were strong predictors of whether or not individuals perceived need, whereas among those who perceived the need for help only older age was positively associated with help-seeking. Few factors clearly distinguished those who did and did not seek help from specialty mental health professionals with the exception of having three or more psychiatric diagnoses. Finally, the most common barrier to help-seeking was a desire to handle problems on one's own. Conclusions A lack of perceived need for mental health services and self-sufficiency beliefs are significant barriers to older adults' use of mental health services.

show abstract

“…47 This is aligned with prior work demonstrating that integrated interventions are more engaging and acceptable to minorities than other intervention approaches. 48-50 Furthermore, this intervention was both brief and simple in comparison with other diabetes interventions suggesting it may be a sustainable strategy for improving patient adherence that can be implemented in primary care or other settings. 51,52 …”

Section: Discussionmentioning

confidence: 99%

Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

McClintock

Morales

Small

et al. 2014

Behavioral Medicine

View full text Add to dashboard Cite

We sought to examine whether there are patterns of oral hypoglycemic agent adherence among primary care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p<0.05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c (HbA1c) < 7% (adjusted odds ratio = 14.52, 95% CI [2.54, 82.99]) at 12 weeks in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions.

show abstract

Integration of Mental Health Services Into Primary Care Overcomes Ethnic Disparities in Access to Mental Health Services Between Black and White Elderly

Cited by 77 publications

References 20 publications

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Correlates of Perceived Need for and Use of Mental Health Services by Older Adults in the Collaborative Psychiatric Epidemiology Surveys

Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

Contact Info

Product

Resources

About