Merced Kritzia, Imel Zac E, Baldwin Scott A, Fischer Heidi, Yoon Tae, Stewart Christine, Simon Greg, Ahmedani Brian, Beck Arne, Daida Yihe, Hubley Sam, Rossom Rebecca, Waitzfelder Beth, Zeber John E, Coleman Karen J
Department of Educational Psychology, University of Utah, Salt Lake City (Merced, Imel); Department of Clinical Psychology, Brigham Young University, Provo, Utah (Baldwin); Kaiser Permanente, Pasadena, California (Fischer, Yoon, Coleman), Seattle (Stewart, Simon), Denver (Beck), and Honolulu (Daida, Waitzfelder); Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Ahmedani); University of Colorado School of Medicine, Aurora (Hubley); HealthPartners Institute, Minneapolis (Rossom); Veterans Evidence-Based Research, Dissemination, and Implementation Center, South Texas Veterans Health Care System, San Antonio (Zeber).
Psychiatr Serv. 2020 Aug 1;71(8):765-771. doi: 10.1176/appi.ps.201800500. Epub 2020 Apr 28.
Disparities in diagnosis of mental health problems and in access to treatment among racial-ethnic groups are apparent across different behavioral conditions, particularly in the quality of treatment for depression. This study aimed to determine how much disparities differ across providers.
Bayesian mixed-effects models were used to estimate whether disparities in patient adherence to antidepressant medication (N=331,776) or psychotherapy (N=275,095) were associated with specific providers. Models also tested whether providers who achieved greater adherence to treatment, on average, among non-Hispanic white patients than among patients from racial-ethnic minority groups attained lower disparities and whether the percentage of patients from racial-ethnic minority groups in a provider caseload was associated with disparities.
Disparities in adherence to both antidepressant medication and psychotherapy were associated with the provider. Provider performance with non-Hispanic white patients was negatively correlated with provider-specific disparities in adherence to psychotherapy but not to antidepressants. A higher proportion of patients from racial-ethnic minority groups in a provider's caseload was associated with lower adherence among non-Hispanic white patients, lower disparities in adherence to psychotherapy, and greater disparities in adherence to antidepressant medication.
Adherence to depression treatment among a provider's patients from racial-ethnic minority groups was related to adherence among that provider's non-Hispanic white patients, but evidence also suggested provider-specific disparities. Efforts among providers to decrease disparities might focus on improving the general skill of providers who treat more patients from racial-ethnic minority groups as well as offering culturally based training to providers with notable disparities.
在不同行为状况下，种族-族裔群体在心理健康问题诊断和治疗可及性方面的差异明显，尤其是在抑郁症治疗质量方面。本研究旨在确定不同医疗服务提供者之间的差异程度有何不同。
采用贝叶斯混合效应模型来估计患者对抗抑郁药物治疗（N = 331,776）或心理治疗（N = 275,095）的依从性差异是否与特定医疗服务提供者相关。模型还测试了那些在非西班牙裔白人患者中平均治疗依从性高于种族-族裔少数群体患者的医疗服务提供者，其差异是否更小，以及医疗服务提供者病例组合中种族-族裔少数群体患者的百分比是否与差异相关。
对抗抑郁药物治疗和心理治疗的依从性差异均与医疗服务提供者相关。医疗服务提供者对非西班牙裔白人患者的治疗表现与该提供者在心理治疗依从性方面的特定差异呈负相关，但与抗抑郁药物治疗无关。医疗服务提供者病例组合中种族-族裔少数群体患者比例较高，与非西班牙裔白人患者较低的依从性、心理治疗依从性方面较小的差异以及抗抑郁药物治疗依从性方面较大的差异相关。
医疗服务提供者的种族-族裔少数群体患者对抑郁症治疗的依从性与该提供者的非西班牙裔白人患者的依从性相关，但有证据也表明存在医疗服务提供者特定的差异。医疗服务提供者减少差异的努力可能集中在提高治疗更多种族-族裔少数群体患者的医疗服务提供者的一般技能，以及为差异显著的医疗服务提供者提供基于文化的培训。
