BACKGROUND The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. METHODS Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. RESULTS The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. CONCLUSIONS This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.

中文翻译：

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实施协作护理，以减少美国农村原住民/阿拉斯加原住民的抑郁症。


背景 本研究的目的是确定协作护理对农村美洲原住民和阿拉斯加原住民 (AI/AN) 患者的影响。方法 协作护理在三个 AI/AN 服务诊所实施。诊所工作人员参加了旨在促进实践改变的培训和辅导。我们对诊所进行了两年的跟踪观察，以观察抑郁症治疗的改善情况并检查入组患者的治疗结果。协作护理要素包括对抑郁症进行普遍筛查、基于证据的目标治疗、使用行为健康护理管理者进行干预、使用精神科顾问提供病例咨询以及质量改进跟踪以改善和维持结果。我们使用 t 检验来评估协作护理的主要效果，并使用多元线性回归来更好地理解成功的预测因素。我们还从协作护理临床团队成员那里收集了有关他们经验的定性数据。结果 诊所参加了针对抑郁症患者实施协作护理的培训和实践指导。与同一诊所的白人患者相比，AI/AN 患者的抑郁反应（根据 PHQ-9 测量，抑郁症状减少 50% 或更多）和缓解（PHQ-9 评分低于 5）率相当。积极治疗结果的重要预测因素包括研究期间仅进行一次抑郁症治疗以及每位患者的更多随访次数。临床医生对他们的经验以及对诊所患者护理的影响总体持积极态度。结论 该项目表明，可以通过农村地区的初级保健机构向 AI/AN 患者提供协作护理。