Njeru Jane W, DeJesus Ramona S, St Sauver Jennifer, Rutten Lila J, Jacobson Debra J, Wilson Patrick, Wieland Mark L
Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ; Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA.
Robert D and Patricia E Kern Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA.
Int J Ment Health Syst. 2016 Feb 29;10:15. doi: 10.1186/s13033-016-0044-z. eCollection 2016.
Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice.
This was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not.
Of the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]).
Within primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among patients with LEP.
与普通人群相比，美国的移民和难民患抑郁症的比例更高，且获得充分心理健康服务和治疗的可能性更小。英语水平有限（LEP）的人群获得充分心理健康护理的风险更高。抑郁症的协作式护理管理（CCM）模式在包括LEP患者在内的广泛患者群体中，对于实现治疗目标是有效的。本研究的目的是评估在一家大型初级保健机构中，一项在全州范围内使用CCM进行抑郁症管理的举措在LEP患者中的利用情况。
这是一项对明尼苏达州一家大型初级保健机构中抑郁症患者的回顾性队列研究。符合CCM纳入标准的患者[电子病历中有医生诊断的抑郁症或心境恶劣，且患者健康问卷-9（PHQ-9）评分≥10]。患者自我认定的口译服务需求被用作LEP的替代指标。测量了参与全州范围内使用CCM进行抑郁症管理的“明尼苏达州抑郁症改善，提供新方向”（DIAMOND）项目的比例。将需要口译服务的合格患者与不需要口译服务的合格患者的参与率进行了比较。
在研究期间符合DIAMOND项目纳入标准的7561名患者中，有351名被纳入。符合条件的LEP患者中只有18.2%被纳入DIAMOND项目，而符合条件的英语熟练患者的这一比例为47.2%。在对年龄、性别和抑郁症严重程度评分的差异进行调整后，这一发现仍然存在（调整后的比值比[95%置信区间]=0.43[0.23，0.81]）。
在初级保健机构中，需要采取针对性的干预措施，包括解决文化能力和语言沟通问题的措施，以提高LEP患者对这种有效模式的利用率。
