Measuring and Tracking Integrated Health Care (METRIHC): Results from a Pilot Study of Latinas with Depression

Purpose: The current study sought to establish the feasibility of universal screening for depression in an adult primary care setting, implement a Measurement-based Integrated Health Care model and measure the effectiveness of subsequent collaborative, multi-disciplinary treatment and care management intervention. The study built on previous research establishing integrated health care as an effective model for the identification and treatment of depression. Clinical depression and related conditions are leading causes of medical disability, health burden, and increased medical cost in the United States. The goals of this innovative university-community partnership were to mobilize the collaborative strengths of a local community health center, the school of social work, and the medical school’s department of psychiatry to improve health care delivery and outcomes while reducing costs for people who struggle with depressive illnesses via implementation of Measurement-based Integrated Health Care. 

Methods: All adult primary care patients at the community health center were screened with the Patient Health Questionnaire (PHQ-9) depression measure and other baseline measures. Patients who screened positive for depression were enrolled in the Measurement-based Integrated Health Care program. The patient population at the community health center was predominantly Spanish-speaking, and the program participants were all Latinas (n=45). Measures were given at every visit, or a minimum of every three months, to track patient health outcomes longitudinally. The integrated health care team included the primary care provider from the community health center, the depression care manager (a social worker), a consulting psychiatrist, and the patient and their family members. A nonparametric, related-samples Wilcoxon signed rank test was conducted in SPSS 22.0.

Results: The final sample had a mean age of 40 (sd=9.48). The majority were married (53.3%), and all but one spoke Spanish as their primary language (97.8%). Baseline PHQ9 scores (mean=18.98, sd=5.35) were significantly different than the scores obtained following completion of the intervention (mean=14.33, sd=6.88). A nonparametric, related-samples Wilcoxon signed rank test revealed positive differences for 31 participants (median rank sum=663), negative differences for 8 (median rank sum=117), and no changes for 6. The Wilcoxon signed rank standardized test statistic was Z=3.82 (p<.001). An effect size was calculated for the intervention using matched-pairs rank-biserial correlation (Kerby, 2014) and resulted in a medium effect size of r=.528.

Implications: Low-income, uninsured, Spanish-speaking Latinas in this primary care clinic were significantly more likely to achieve clinical improvement in their depressive symptoms after receiving care from an Integrated Health Care Team. Depression care managers can ensure a treatment plan is being followed, monitor symptoms and medication side effects, educate patients about their disease, encourage self-management techniques, and provide brief interventions. Since Latinas are more likely to receive mental health care in primary care settings, results suggest an opportunity to reduce disparities for populations who lack access to mental health specialists.