Is a patient navigation program more helpful than a referral program for reducing depression and improving quality of life among women living in neighborhoods with few resources?
While no subgroups showed differences in depression outcomes, several subgroups reported greater QOL in at least 1 domain in response to PSP compared with ESR, including those patients with high anxiety, perception of being unable to afford mental health treatment, high pain, and IPV in the past yea...
| Main Authors: | , , , |
|---|---|
| Corporate Author: | |
| Format: | eBook |
| Language: | English |
| Published: |
[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
[2019], 2019
|
| Series: | Final research report
|
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | While no subgroups showed differences in depression outcomes, several subgroups reported greater QOL in at least 1 domain in response to PSP compared with ESR, including those patients with high anxiety, perception of being unable to afford mental health treatment, high pain, and IPV in the past year. CONCLUSIONS: In summary, there were no differences between groups for the primary outcomes. We found that patients in both groups found the interventions satisfactory and experienced improvement in depression. Patients with additional social barriers, psychological barriers, and health comorbidities were more likely to show improvement in their QOL if they received PSP rather than ESR. Our community advisory board--comprising researchers, practitioners, policymakers, and stakeholders--agree that our findings hold promise to improve patient-centered care and outcomes for a particularly vulnerable group of patients, many of whom are mothers. BACKGROUND: Disproportionate exposure to adversities such as poverty, intimate partner violence (IPV), and single parenthood status is associated with socioeconomic disadvantage among woman in the United States. The co-occurring experiences of depression and chronic stress among women's health patients who are socioeconomically disadvantaged dramatically exacerbate one another. Decontextualized care fails to respond to the real-life priorities of patients, resulting in low satisfaction, poor engagement, and poor outcomes. It is critical to incorporate personalized interventions that fit patients' identified needs. OBJECTIVES: We evaluated 2 interventions among women's health patients with socioeconomic disadvantage and depression: Enhanced Screening and Referral (ESR), a systematic screening intervention with facilitated referral, and Personalized Support for Progress (PSP), a patient navigation intervention tailored to patients' priorities. We further assessed patients with elevated depressive symptoms for inclusion criteria; if they were eligible and consenting, we enrolled and randomized them to PSP or ESR. Patients in the PSP group met with a patient navigator to complete a tool to prioritize their needs, develop a care plan, and implement the plan. Patients in the ESR group received a personalized list of resources based on their identified needs and monthly check-in phone calls offering assistance with connecting to those resources. The active intervention phase lasted 4 months. Patients completed further assessments at baseline, immediately posttreatment, and at 3 months and 6 months after treatment. RESULTS: The 223 patients in both arms found the interventions highly satisfactory and showed improvement in depression symptoms compared with baseline. PSP patients reported greater satisfaction in some areas. There were no differences between the groups for depression and QOL outcomes. Study limitations include the lack of a care as usual group, the fact that both intervention arms are not highly standardized and vary between patients, and that we found some group differences at baseline. Our next step is to determine if PSP generalizes to IPV victims in a medical-legal partnership clinic in our new PCORI-funded comparative effectiveness trial.52 Our overarching goals were to determine which intervention was more satisfactory and effective for depression and quality of life (QOL):1. Aim 1. Determine satisfaction among patients receiving PSP and ESR.2. Aim 2. Compare outcomes of PSP with those of ESR for depression and QOL.3. Aim 3. Identify which patients are particularly likely to benefit from PSP compared with ESR. METHODS: A research assistant approached patients in the waiting room of 3 women's health clinics that target patients with socioeconomic disadvantage. Patients completed a tablet-based psychosocial assessment, including screens for depression (Patient Health Questionnaire-9); anxiety (General Anxiety Disorder-7); IPV (Feldhaus); practical needs such as housing, food, and transportation; illicit substance (Drug Abuse Screening Test) and alcohol (Alcohol Use Disorders Identification Test-Concise) use; and chronic pain and disability (WHO-Disability Assessment Schedule). |
|---|---|
| Physical Description: | 1 PDF file (77 pages) illustrations |