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Improving outcomes for low-income mothers with depression: a comparative effectiveness trial of two brief interventions in the patient-centered medical home
Investigator (PI): Silverstein, Michael
Performing Organization (PO): (Current): Boston Medical Center, Department of Pediatrics, Division of General Pediatrics / (617) 638-8000
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2017
Final Year: 2021
Record Source/Award ID: PCORI/AD-1603-34662
Funding: Total Award Amount: $2,097,587
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: In 2016, the United States Preventive Services Task Force (USPSTF) updated its recommendation for screening adults for depression in primary care. For the first time, it designated pregnant and postpartum women as specific groups whose screening can lead to better outcomes. The USPSTF, however, also determined that depression screening is beneficial only when programs exist to ensure that patients who screen positive are appropriately diagnosed and treated or referred to a setting that can provide appropriate care. Our current PCORI proposal addresses high-priority evidence gaps regarding perinatal depression, as outlined by the USPSTF. We will compare two primary care-based engagement strategies, based on the construct of screening, brief intervention, and referral to treatment. While both comparators share the same universal depression screening strategy, they differ in their brief intervention approaches. The first comparator is Engagement-Focused Care Coordination, in which the brief intervention is the Engagement Interview. In this model, bachelor-level providers meet one to two times with mothers who screen positive for depression and use techniques of shared decision making and motivation building to help mothers process the results of the screen, explore treatment options, and connect with formal mental health services. The second comparator is Problem Solving Education (PSE), in which the brief intervention is a six-session cognitive behavioral program, also delivered by bachelor-level providers. Whereas Engagement-Focused Care Coordination emphasizes referral to formal mental health services, PSE follows a stepped-care model in offering immediate, low-level depression treatment in the primary care setting, followed by referral to further treatment if symptoms persist. Our study addresses three questions related to mental health disparities, all of which are relevant to patients: (1) What is the most effective strategy to improve outcomes among a screened population of pregnant and postpartum women with depressive symptoms? (2) When is the optimal time (pregnancy or postpartum) to deploy each strategy? (3) What are the barriers to establishing these interventions in medical home settings? Developed through a longstanding collaboration with our stakeholder advisory board, our trial is designed to evaluate whether providing first step depression treatment in the medical home delivered by peer providers enhances uptake of services and improves outcomes among a screened population of pregnant and postpartum women. Answering this question will allow mothers to make informed decisions regarding how and where to receive depression care; further, it will allow practice managers to make informed decisions regarding how to organize key components of the patient-centered medical home. Our ultimate goal is to reduce disparities in access to mental health care for low-income mothers and to improve outcomes for them and their children.
MeSH Terms:
  • Cognitive Behavioral Therapy /methods
  • Comparative Effectiveness Research
  • Decision Making
  • Depression /*complications
  • /*therapy
  • Depression, Postpartum /diagnosis
  • Female
  • Health Services Accessibility
  • Health Status Disparities
  • Healthcare Disparities
  • Humans
  • Mass Screening /methods
  • Mental Disorders /diagnosis
  • Outcome Assessment, Health Care
  • Patient Participation
  • Patient-Centered Care /*organization & administration
  • Postpartum Period
  • * Poverty
  • Pregnancy
  • Pregnancy Complications /diagnosis
  • Preventive Medicine /methods
  • /*organization & administration
  • Primary Health Care /organization & administration
  • Problem Solving
  • Program Development
  • Referral and Consultation
  • Time Factors
  • United States
Country: United States
State: Massachusetts
Zip Code: 02118
UI: 20181362
CTgovId: NCT03221556
Project Status: Ongoing