RAND Corporation, 1776 Main St., Santa Monica, CA 90401, USA.
Psychiatr Serv. 2010 Nov;61(11):1112-8. doi: 10.1176/ps.2010.61.11.1112.
This study assessed treatment preferences among low-income Latino patients in public-sector primary care clinics and examined whether a collaborative care intervention that included patient education and allowed patients to choose between medication, therapy, or both would increase the likelihood that patients received preferred treatment.
A total of 339 Latino patients with probable depressive disorders were recruited; participants completed a baseline conjoint analysis preference survey and were randomly assigned to receive the intervention or enhanced usual care. At 16 weeks, a patient survey assessed depression treatment received during the study period. Logistic regression models were constructed to estimate treatment preferences, examine patient characteristics associated with treatment preferences, and examine patient characteristics associated with a match between stated preference and actual treatment received.
The conjoint analysis preference survey showed that patients preferred counseling or counseling plus medication over antidepressant medication alone and that they preferred treatment in primary care over specialty mental health care, but they showed no significant preference for individual versus group treatment. Patients also indicated that individual education sessions, telephone sessions, transportation assistance, and family involvement were barrier reduction strategies that would enhance their likelihood of accepting treatment. Compared with patients assigned to usual care, those in the intervention group were 21 times as likely to receive preferred treatment. Among all participants, women, unemployed persons, those who spoke English, and those referred by providers were more likely to receive preferred treatment.
Collaborative care interventions that include psychotherapy can increase the likelihood that Latino patients receive preferred care; however, special efforts may be needed to address preferences of working persons, men, and Spanish-speaking patients.
本研究评估了公共部门初级保健诊所中低收入拉丁裔患者的治疗偏好，并考察了一种包括患者教育且允许患者在药物治疗、心理治疗或两者之间进行选择的协作式护理干预措施是否会增加患者接受首选治疗的可能性。
共招募了 339 名患有疑似抑郁障碍的拉丁裔患者；参与者完成了基线联合分析偏好调查，并被随机分配接受干预或增强的常规护理。在 16 周时，患者调查评估了研究期间接受的抑郁治疗情况。构建了逻辑回归模型来估计治疗偏好，考察与治疗偏好相关的患者特征，并考察与患者首选治疗与实际接受治疗相匹配的患者特征。
联合分析偏好调查显示，患者更倾向于选择咨询或咨询加药物治疗，而不是单独使用抗抑郁药物，并且他们更倾向于在初级保健中接受治疗，而不是在专业心理健康护理中接受治疗，但他们对个体治疗与小组治疗没有明显偏好。患者还表示，个体教育课程、电话咨询、交通援助和家庭参与是降低障碍的策略，会增加他们接受治疗的可能性。与接受常规护理的患者相比，接受干预的患者接受首选治疗的可能性高 21 倍。在所有参与者中，女性、失业者、讲英语者和由提供者转介的患者更有可能接受首选治疗。
包括心理治疗的协作式护理干预可以增加拉丁裔患者接受首选治疗的可能性；然而，可能需要特别努力来解决在职人员、男性和讲西班牙语患者的偏好问题。
