Regular Research ArticlesIntegration of Mental Health Services Into Primary Care Overcomes Ethnic Disparities in Access to Mental Health Services Between Black and White Elderly
Section snippets
Design
The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study is a randomized clinical trial designed to compare integrated versus enhanced referral models of MH/SA treatment for older adults with depression, anxiety, and/or problem drinking. For a detailed description of study design, see Levkoff et al.19
In the present study, we report data from 1 of 10 U.S study sites, comparing engagement and participation rates in black and white elderly in the two
RESULTS
Demographic and clinical characteristics of the sample are described in Table 1. Eighty-two participants (60% black) were assigned to the enhanced referral arm and 73 (54% black) were assigned to the integrated treatment arm. There were no statistically significant differences between the enhanced referral and the integrated models of care within each ethnic group. However, statistically significant differences between the white and the black samples were evident, with the white sample being
HAVING AT LEAST ONE MH/SA VISIT
After adjusting for all covariates, the interaction between ethnicity and model of care was significant (odds ratio [OR]: 0.21, confidence interval [CI]: 0.046– 0.96, Wald χ2: 4.02, df = 1, p = 0.04). Results indicated that black elderly in the integrated arm were significantly more likely to have at least one MH/SA visit (77.5%) than blacks in the enhanced referral arm (22%). There was no statistically significant difference between white elderly in the integrated model of care (66.6%) and
OVERALL NUMBER OF MH/SA VISITS
In predicting overall number of visits, controlling for all covariates, we found a significant interaction between ethnicity and treatment assignment (incident rate ratio [IRR]: 0.20; CI: 0.06–61, Wald χ2: 8.00, df = 1, p = 0.005). We then compared the two ethnic groups within each treatment arm because the two models of care advocate different lengths of treatment. In the enhanced referral arm, Blacks had a significantly smaller number of overall MH/SA visits (mean [SD]: 2.08 [5.28]) relative
TIME TO FIRST MH/SA VISIT
Controlling for all covariates and stratifying by level of education, we used Cox regression analysis to assess time between baseline evaluation to first MH/SA visit. The interaction between ethnicity and treatment assignment was statistically significant (hazard ratio [HR]: 0.31; CI: 0.11–0.89, Wald χ2: 4.66, df = 1, p = 0.03). However, time from baseline evaluation to engagement in first MH/SA visit was significantly shorter in the integrated arm for both blacks (mean days [SD]: 31.06
DISCUSSION
This study is unique because it evaluates ethnic minority engagement and participation in integrated MH/SA services against a strong alternative, an enhanced referral model of care that actively encourages participation in MH/SA services. Results are encouraging and suggest that the integration of MH/SA treatment into primary care clinics results in better access to and greater use of MH/SA services among black elderly, even in comparison to a strong alternative such as the enhanced referral
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Cited by (0)
This work was supported by the Substance Abuse and Mental Health Services Administration, Veterans Affairs, and the Health Resources and Services Administration.
Presented in part at the annual meeting of the American Association of Geriatric Psychiatry, 2006.