Monitored Care Decreases Gap in Depression Treatment for Minorities
Increasing patient education and monitoring can decrease the gap in treatment outcomes among whites and minorities with depression, according to a study published in the April issue of Archives of General Psychiatry, the Wall Street Journal reports. The study, led by researchers from the University of California-Los Angeles and RAND, followed 1,356 patients with depression who were enrolled in the Patients in Care study and divided them among 46 randomly selected clinics to receive one of three depression treatments. Patients were permitted to choose to receive "usual care," under which a primary physician could prescribe medication or refer a patient to a counselor; closely monitored psychotherapy; or closely monitored medications. They also could choose to receive no treatment. Health providers at 30 of the 46 health centers were trained on the two "more-intensive intervention programs," the Journal reports. Of the 991 participants who completed a telephone follow-up interview five years after the study began, 56% of African Americans and Hispanics and 36% of whites who chose "usual care" were considered likely to be depressed. The gap was smaller for patients who participated in monitored medicine programs, with 45% of minorities being considered likely depressed, compared with 32% of whites. The gap was the smallest for patients who received monitored psychotherapy -- 36% of minorities were considered likely depressed compared with 34% of whites (Windham, Wall Street Journal, 4/6). According to a release from RAND, "the interventions caused a small overall improvement in depression outcomes. But the improvements seen among minority patients were large enough to erase the disparities in depression outcomes seen between minority patients and their white peers in standard care." Lead researcher Kenneth Wells, a professor of psychiatry and behavioral sciences at UCLA and a senior scientist at RAND, said, "These findings provide a hopeful message: An initial improved care experience can have lasting benefits overall and among minorities, while reducing disparities in outcomes of care between minority and white patients" (RAND release, 4/5). Ronald Kessler, a professor of health care policy at Harvard Medical School, said, "This is an example of something that can be done to close the gap" (Wall Street Journal, 4/6). An abstract of the study is available online.
In related news, the American Public Health Association on Monday launched a weeklong program to draw attention to racial and ethnic health disparities in the United States, Long Island Newsday reports. Dr. Georges Benjamin, the executive director of the Washington-based group, said, "We've been measuring the differences in health outcomes for years. ... While progress has been made, it's inadequate. In many cases these unacceptable gaps remain and some have increased." He added, "National Public Health Week 2004 is about moving communities nationwide from statistics to solutions." According to WHO rankings, while the United States ranked first of 191 nations on health care spending -- spending an overage of $4,187 per person on health care in 2000 -- the nation ranked 37 in supplying overall health care for all residents. Surgeon General Richard Carmona, who attended the program's launch, said, "The irony of health literacy is that those who need it the most have it the least." Carmona added, "We must reach out to all communities of color and make them understand what is in their immediate control" (Vissat, Long Island Newsday, 4/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.