Patient-Centered Depression Care in the Public Sector

University Of Southern California, Los Angeles CA

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): For depression care to be sustainable in public sector primary care settings, it must accommodate patient preferences and the priorities and capacities of providers and administrators. This application aims to directly address the need for information on how to assess and incorporate the preferences of patients, providers, and administrators into the design of a depression intervention. In 3 large public sector primary care centers serving mostly low-income Latinos, we assess the depression care preferences and resources of patients, providers, and administrators. To do so, we use mixed qualitative and quantitative methods and a novel application of conjoint analysis, a marketing research method. Next, we randomize 100 patients at each clinic (300 patients total) to a standardized depression intervention vs. wait list control, not for the traditional purpose of studying intervention effects on patient outcomes, but rather for providing patients, clinicians, and administrators with a treatment exposure. We then examine whether stated preferences before the intervention correspond to the actual behaviors of patients, providers, and administrators when provided with an opportunity for care, and whether exposure to depression treatment or improved outcomes change stated preferences for care. Finally, we conduct a multi-stakeholder negotiation process to prioritize consumer oriented- preferences for care given resource constraints. At study end, we will have gained information regarding the preferences of multiple stakeholders in public sector care and on how public primary care systems can weigh not only the often harsh realities of public sector practice constraints, but also the needs and priorities of informed consumers, in efforts to improve care.