Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, North Little Rock, AR, USA.
Am J Psychiatry. 2013 Feb;170(2):218-25. doi: 10.1176/appi.ajp.2012.12030375.
The authors examined the effects of a collaborative care intervention for anxiety disorders in primary care on lower-income participants relative to those with higher incomes. They hypothesized that lower-income individuals would show less improvement or improve at a lower rate, given that they would experience greater economic stress over the treatment course. An alternative hypothesis was that lower-income participants would improve at a higher rate because the intervention facilitates access to evidence-based treatment, which typically is less available to persons with lower incomes.
Baseline demographic and clinical characteristics of patients with lower (N=287) and higher (N=717) income were compared using t tests and chi-square tests for continuous and categorical variables, respectively. For the longitudinal analysis of intervention effects by income group, the outcome measures were jointly modeled at baseline and at 6, 12, and 18 months by study site, income, time, intervention, time and intervention, income and time, income and intervention, and time, intervention, and income.
Although lower-income participants were more ill and had greater disability at baseline than those with higher incomes, the two income groups were similar in clinical response. The lower-income participants experienced a comparable degree of clinical improvement, despite receiving fewer treatment sessions, less relapse prevention, and less continuous care.
These findings contribute to the ongoing discussion as to whether or not, and to what extent, quality improvement interventions work equally well across income groups or require tailoring for specific vulnerable populations.
作者研究了初级保健中针对焦虑障碍的协作式护理干预对低收入参与者与高收入参与者的影响。他们假设，由于在治疗过程中会经历更大的经济压力，低收入个体的改善程度会较低或改善速度会较慢。另一种假设是，低收入参与者的改善速度会更快，因为该干预措施有助于获得基于证据的治疗，而这种治疗通常对低收入者来说较少。
使用 t 检验和卡方检验分别比较低收入（N=287）和高收入（N=717）患者的基线人口统计学和临床特征。对于按收入分组的干预效果的纵向分析，通过研究地点、收入、时间、干预、时间和干预、收入和时间、收入和干预以及时间、干预和收入，对基线和 6、12 和 18 个月的结局指标进行联合建模。
尽管低收入参与者在基线时比高收入参与者病情更严重且残疾程度更高，但这两个收入组的临床反应相似。尽管接受的治疗次数较少、预防复发较少且持续护理较少，但低收入参与者经历了相当程度的临床改善。
这些发现有助于持续讨论质量改进干预措施是否以及在何种程度上在不同收入群体中同样有效，或者是否需要针对特定弱势群体进行定制。
