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Psychiatr Serv. 2018 Apr 1;69(4):431-437. doi: 10.1176/appi.ps.201700067. Epub 2018 Jan 16.

A Comparison of Collaborative Care Outcomes in Two Health Care Systems: VA Clinics and Federally Qualified Health Centers.

Author information

1
Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock.

Abstract

OBJECTIVE:

Collaborative care for depression results in symptom reduction when compared with usual care. No studies have systematically compared collaborative care outcomes between veterans treated at Veterans Affairs (VA) clinics and civilians treated at publicly funded federally qualified health centers (FQHCs) after controlling for demographic and clinical characteristics.

METHODS:

Data from two randomized controlled trials that used a similar collaborative care intervention for depression were combined to conduct post hoc analyses (N=759). The Telemedicine-Enhanced Antidepressant Management intervention was delivered in VA community-based outpatient clinics (CBOCs), and the Outreach Using Telemedicine for Rural Enhanced Access in Community Health intervention was delivered in FQHCs. Multivariate logistic regression was used to determine whether veteran status moderated the effect of the intervention on treatment response (>50% reduction in symptoms).

RESULTS:

There was a significant main effect for intervention (odds ratio [OR]=5.23, p<.001) and a moderating effect for veteran status, with lower response rates among veterans compared with civilians (OR=.21, p=.01). The addition of variables representing medication dosage and number of mental health and general health appointments did not influence the moderating effect. A sensitivity analysis stratified by gender found a significant moderating effect of veteran status for men but not women.

CONCLUSIONS:

Veteran status was a significant moderator of collaborative care effectiveness for depression, indicating that veterans receiving collaborative care at a CBOC are at risk of nonresponse. Unmeasured patient- or system-level characteristics may contribute to poorer response among veterans.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00439452.

KEYWORDS:

Community Health Services; Depression; Treatment Outcome; Veteran

PMID:
29334874
DOI:
10.1176/appi.ps.201700067
[Indexed for MEDLINE]

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