Reducing Health Disparities in Depressive Disorders Outcomes between Non-Hispanic Whites and Ethnic Minorities

Voorhees, Benjamin W. Van; Walters, Amy E.; Prochaska, Micah T.; Quinn, Michael T.

doi:10.1177/1077558707305424

Cited by 61 publications

(48 citation statements)

References 112 publications

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“…Case management–based interventions that have successfully narrowed disparities in other patient populations are multicomponent interventions that have simultaneously targeted health care system, provider, and patient factors through a chronic disease management approach (27). Thus ACT’s equity effects could be strengthened if features of the chronic care model (28) that are not considered core elements of ACT were added to it.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

Horvitz-Lennon

Zhou²,

Normand³

et al. 2011

Psychiatric Services

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Objective Case management–based interventions aimed at improving quality of care have the potential to narrow racial and ethnic disparities among people with chronic illnesses. The aim of this study was to assess the equity effects of assertive community treatment (ACT), an evidence-based case management intervention, among homeless adults with severe mental illness. Methods This study used baseline, three-, and 12-month data for 6,829 black, Latino, and white adults who received ACT services through the ACCESS study (Access to Community Care and Effective Services and Support). Zero-inflated Poisson random regression models were used to estimate the adjusted probability of use of outpatient psychiatric services and, among service users, the intensity of use. Odds ratios and rate ratios (RRs) were computed to assess disparities at baseline and over time. Results No disparities were found in probability of use at baseline or over time. Compared with white users, baseline intensity of use was lower for black users (RR=.89; 95% confidence interval [CI]=.83–.96) and Latino users (RR=.65; CI=.52–.81]). Intensity did not change over time for whites, but it did for black and Latino users. Intensity increased for blacks between baseline and three months (RR=1.11, CI=1.06–1.17]) and baseline and 12 months (RR=1.17, CI=1.11–1.22]). Intensity of use dropped for Latinos between baseline and three months (RR=.83, CI=.70–.98). Conclusions Receipt of ACT was associated with a reduction in service use disparities for blacks but not for Latinos. Findings suggest that ACT’s equity effects differ depending on race-ethnicity.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

Horvitz-Lennon

Zhou²,

Normand³

et al. 2011

Psychiatric Services

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“…We looked across these reviews and Finding Answers' previous research, [11][12][13][14][15][16][17] and identified several cross-cutting themes. Our findings showed that promising interventions frequently were multi-factorial, targeting multiple leverage points along a patient's pathway of care.…”

Section: Cross-cutting Themesmentioning

confidence: 99%

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

et al. 2012

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Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

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“…Van Voorhees et al found that multicomponent interventions, using either chronic disease management or collaborative care models that affect the larger health care system, health care organization, provider, and person-level factors, improved the health outcomes of ethnic minorities with depression (Van Voorhees et al 2007). The interventions addressed the continuum of factors in the process from individual patient assessment for depression to navigation through the health care system.…”

Section: Depressionmentioning

confidence: 99%

“…For example, increasing breast cancer screening is only useful if patients have timely diagnostic testing after an abnormal mammogram and appropriate treatment for breast cancer (Masi, Blackman, and Peek 2007). Effective depression interventions addressed evaluation, treatment, completion of treatment, access to providers, and payment (Van Voorhees et al 2007). Some of the most powerful diabetes interventions targeted patient, provider, organization, and community factors simultaneously (Peek, Cargill, and Huang 2007).…”

Section: Multifactorial Interventions That Address Multiple Levers Ofmentioning

confidence: 99%

Interventions to Reduce Racial and Ethnic Disparities in Health Care

et al. 2007

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In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventions and make recommendations for future interventions to reduce disparities. Multifactorial, culturally tailored interventions that target different causes of disparities hold the most promise, but much more research is needed to investigate potential solutions and their implementation.

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Reducing Health Disparities in Depressive Disorders Outcomes between Non-Hispanic Whites and Ethnic Minorities

Cited by 61 publications

References 112 publications

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

Interventions to Reduce Racial and Ethnic Disparities in Health Care

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