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Grant to help study Latino health care Jessica Shelby, Daily Times
04/12/2007
Is there a better way to address depression treatment for the Latino population? A recent research grant - Finding Answers - will be used to help answer that question, according to Beth Marootian, the director of business development at Neighborhood Health Plan. The grant, in the sum of $261,000 to be distributed over a two-year period, was awarded to three principal investigators, Neighborhood Health Plan of Rhode Island, Butler Hospital and Beacon Health Strategies. The three partners will be using the funds, which come from the National Program Office of the Robert Wood Johnson Foundation, housed at the University of Chicago, to "evaluate the effectiveness of telephone-based, culturally sensitive depression care management for Latino primary care patients," Marootian said.
"The request from Robert Wood Johnson was that folks submit proposals for the grant money that would evaluate disparities in regard to coronary heart disease, depression and diabetes," Marootian said. "For us, our focus was in the area of depression." Neighborhood, Marootian said, had been doing a number of interventions with providers prior to the grant opportunity arising, so, immediately after learning about the grant, the group applied.
"Because we have a very ethnically and racially diverse membership as the Medicaid-only plan for the state, Neighborhood has always had a long-standing commitment to understanding how to better serve our members," Marootian said. "Right along, we have been doing a lot around member education that is culturally sensitive and presented at a second-grade literacy level, we have been finding ways to bring material and info to our members to help them understand how to take care of their own health as well as understand the health system, and we thought that this grant would be a really nice opportunity to be able to dig deeper into something that we've already been doing with the existing interventions." Interventions might include providing tools to primary health care providers for diagnosing and treating depression, or providing information to group members.
What Marootian said Neighborhood already knew from existing membership data was that "Latinos who receive a diagnosis of depression almost immediately begin to have gaps in care when compared to whites in [Neighborhood's] membership base."
Neighborhood is not sure why this is, Marootian said.
"What we do know is that it is typical of this population to not keep routine doctor visits after diagnosis, that they are not staying on the medications prescribed to them as long as they should be and that they are generally not getting checked up later on in their course of treatment," Marootian said. "What we are planning to use some of the grant money for is to bring in this new form of intervention - a depression care manager - to see if it makes a difference."
What depression care managers, who will all be bilingual and bicultural, though non-clinical, will be doing, according to Marootian, is working with members who have received formal diagnoses of depression.
The care managers will make regular phone calls to check in with members in order to maintain continuous contact with those patients, she said. "The depression care managers are not doctors and nurses, they are bachelor-prepared folks and there is a reason for that," Marootian said. "We really wanted to create a model that was non-medical. We wanted it to be an extension of the doctors and the clinical team who prescribe and diagnosis."
The depression case managers, Marootian said, will not be doing treatment nor will they be talking with the participants about all their problems, though they will be asking basic questions, like "How are you feeling?" and "Are you taking your medications as prescribed?"
Depression is a chronic illness, so it's vital for those with the condition to take their medications, Marootian said.
Participants in the study are all Neighborhood members, according to Marootian. The opportunity to participate is open anybody in the membership base with a diagnosis of depression who is over the age of 18 and who wants to participate.
Neighborhood will be sending a letter out to all members inviting them to participate in the study, Marootian said.
All of those members with diagnoses of depression who respond to the research study with an interest will be accepted to participate, she said, though the group will be divided randomly.
"Everybody that responds and says that they want to participate will receive a phone call that says 'Do you want depression care manager services?' while other folks will get a call that asks 'Would you like to be part of a study? We are looking at depression in Latinos.'" Marootian said.
"They will be our treatment-as-usual group. We will not do any special interventions with them though we will call them and do the same assessments that we do with the treatment group so that we have a controlled group and then compare the two over an 18-month period," she said. The goal of the study, Marootian said, is to try and understand if the use of the depression care managers helps to alleviate symptoms of depression over time.
If the study delivers positive results, Marootian said Neighborhood and Beacon Health Strategies will "potentially implement" this as a permanent option for members. She said the programs are willing to pay for the option if it helps, but don't want to spend on ineffective treatment. Beacon is also interested in seeing if the model could be used for other clients as well as other Neighborhood members, Marootian said.
The active phase of recruitment for this study is expected to begin within the next few weeks. Once all of the participants are confirmed, the first 18 months of the grant will be used for testing, and the remaining six months will be used for evaluation and reporting, according to Marootian. Click here to view RWJ "Finding Answers" grant fact sheet |
