Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions

In: Ethnicity & disease: an international journal on population differences in health and disease patterns, Volume 28, Issue Supp, p. 325-338

Abstract

Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Re­sources for Services (RS) for program techni­cal assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical condi­tions (MCC) are unknown.Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups.Design: Secondary analyses of a cluster-randomized trial.Setting: 93 health care and community-based programs in two neighborhoods.Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Question­naire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys.Intervention: CEP or RS for implementing depression quality improvement programs.Outcomes and Analyses: Primary: depres­sion (PHQ9 ≥10), poor MHRQL (Short Form Health Survey, SF-12<40); Second­ary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate interven­tion effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by- MCC interactions (exploratory).Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increas­ing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC.Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.Ethn Dis. 2018;28(Suppl 2):325-338; doi:10.18865/ed.28.S2.325.