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Gender and Depression: Treatment, QI and Outcomes
Key aims: Identify differences in quality of care received (e.g., appropriate medications, adequate levels of counseling, or both), compliance, and health outcomes (e.g., clinical symptoms, health-related quality of life, family and sexual functioning, side effects of medication) for depressed men and women. Identify factors [e.g., predisposing (sociodemographic and attitudinal), enabling (income, insurance, competing family demands), and need (comorbid psychiatric and medical conditions)] that explain differences between men and women in quality of care received, compliance, and health outcomes.
Determine if Quality Improvement (QI) programs (1) reduce existing disparities in quality of care and outcomes for men and women, (2) improve quality of care and outcomes equally for both, and (3) have similar costs and cost-effectiveness. Identify predisposing, enabling, and need factors that explain differences in how QI programs affect outcomes for men and women. Determine if appropriate treatment differentially affects outcomes for depressed men and women, and explore the extent to which medication-based or therapy-based treatment, or both in combination affect outcomes for men and women. Methods: We will analyze data from the Partners in Care (PIC) study, an AHRQ-funded Patient Outcomes Research Team (PORT)-II, and the Quality Improvement for Depression (QID), a multi-study collaboration to support meta-analysis across quality improvement studies for depression in primary care. Significance: Primary care facilities are a particularly important setting in which to examine gender differences in treatments received and outcomes, since the majority of men and women with depressive disorders or symptoms receive their only health care in such settings (Regier et al. 1993). In addition, among those patients with disorder, only about half are recognized as depressed by their clinicians, and of those recognized, efficacious treatment is moderate to low (Ormel et al. 1991; Katon et al. 1992). Data on what happens over time to depressed men and women in primary care settings provide valuable information to inform clinical care. Knowing whether QI efforts impact care and outcomes differentially for men and women is necessary for developing equitable QI programs. However, this knowledge does not tell us the extent to which appropriate treatment received by patients in typical practice settings is equally effective for men and women. Aim 2 addresses this issue by assessing whether treatment provided in primary care settings under natural conditions produces or exacerbates gender differences in compliance and outcomes. Clinical trials have established the efficacy of treatments for depression. Yet, they usually provide treatments according to highly standardized protocols and tend to exclude typical patients with comorbidities. Such studies do not show whether treatments that work in controlled settings work in typical primary care settings for both men and women. Current status: Analyses ongoing. |
Principal Investigator: Sponsored by: |
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Last updated on 4/11/2007 |