Table 1.
Comparison of Intervention Components, Rationale, and Expected Outcomes: The BRIDGE Study
| Intervention Components | Rationale for Intervention Components | Standard | Patient-Centered | Expected Outcome/Improvement |
|---|---|---|---|---|
| Clinician interventions | ||||
| Standard academic detailing | PCPs infrequently use guideline-concordant strategies for depression care. PCP education is effective but only when combined with other approaches. | X | Improve recognition and management of depression; promote guideline-concordant care | |
| Case-based, academic detailing | PCPs engage in less PDM and rapport building with AAs. Patient-centered and cultural communication skills programs improve patient-reported outcomes. | X | Expected outcomes from standard intervention plus enhance PCP participatory communication skills; improve patient experiences and MH outcomes | |
| Monthly newsletters | See rationale for standard and case-based academic detailing above. | X | X | Enhance knowledge of evidence base of treatments for depression in general (standard) and specifically for AAs (patient-centered) |
| Consultative-liaison psychiatrist | Access to collaborative, expert support system enhances initiation and maintenance of treatment of depression in PC settings. | X | X | Enhance initiation and maintenance of treatment. Assist PCP with management of complex patients; enhance MH outcomes |
| Patient interventions | ||||
| Depression case manager | ||||
| Initial needs assessment | Time and resources to comprehensively assess depressed patients’ symptoms, barriers and influencing factors are limited in PC settings. | X | Increase efficiency and effectiveness of patients’ PC depression evaluation; improve initiation of treatment | |
| Staff expertise to assess access barriers (e.g., cultural beliefs, attitudes, preferences), social context, and communication problems are lacking in PC. | X | Expected outcomes from standard intervention plus overcome cultural/social barriers to care; individualize treatment goals | ||
| Ongoing follow-up: Education/activation; Supportive counseling | Attrition from treatment is high among PC patients with depression. Patient self-efficacy and adherence to treatment improves depression outcomes. | X | Improve patient knowledge of depression, self-efficacy, adherence to treatment, and depression and functional status outcomes | |
| Access barriers, social context issues, and poor relationships with health professionals (lower trust, PDM) contribute to disparities in depression care. | X | Expected outcomes from standard intervention plus overcome barriers, increase acceptance of treatment; and improve relationships with health professionals | ||
| Education materials | Patients with depression desire information about their illness and various treatments | X | Improve knowledge about depression among patients and family members | |
| AAs have concerns about use of spirituality, addictiveness of medications, and experiences of care. Culturally targeted messages address these barriers. | X | Expected outcomes from standard intervention plus improve attitudes; dispel misconceptions about treatment; support use of spirituality for positive coping | ||
BRIDGE, Blacks Receiving Interventions for Depression and Gaining Empowerment; AA, African American; MH, mental health; PC, primary care; PCP, primary care clinician; PDM, participatory decision making.