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Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly.
Am J Geriatr Psychiatry. 2007 Oct; 15(10):906-12.AJ

Abstract

OBJECTIVE

The authors evaluated whether the integration of mental health into primary care overcomes ethnic disparities in access to and participation in mental health (MH) and substance abuse (SA) treatment.

METHODS

The authors conducted site-specific analysis of a multisite clinical trial to compare participation of black and white elderly in an integrated model of care (all MH/SA services are provided at primary care clinics) versus an enhanced referral model of care (all MH/SA services are provided at specialized MH clinics). In all, 183 elderly (56% black) diagnosed with depression (82%), anxiety (32%), and/or problem drinking (22%) were randomized.

RESULTS

Blacks in the integrated arm were significantly more likely to have at least one MH/SA visit (77.5%) relative to blacks in the enhanced referral arm (22%; adjusted odds ratio [OR]: 14.13; confidence interval [CI]: 4.76-41.95, Wald chi(2): 22.75, df = 1, p <0.0001). There was no statistically significant difference between whites in the integrated treatment arm (66.6%) and whites in the enhanced referral arm (46.9%, adjusted OR: 2.98; CI: 0.98-9.06, Wald chi(2): 3.72, df = 1, p = 0.05). In the enhanced referral arm, blacks had a significantly smaller number of overall MH/SA visits (mean [SD]: 2.08 [5.28]) relative to whites (mean [SD]: 5.31 [7.76], adjusted incident rate ratio [IRR]: 2.87; CI: 1.06-7.73, Wald chi(2): 4.37, df = 1, p = 0.03). In the integrated arm, there was no statistically significant difference between blacks (mean [SD]: 3.22 [3.71]) and whites (mean [SD]: 2.75 [4.29], adjusted IRR: 0.58; CI: 0.25-1.33, Wald chi(2): 1.64, df = 1, p = 0.20). For both groups, time between baseline evaluation to first MH/SA visit was significantly shorter in the integrated treatment arm (for blacks: mean days [SD]: 31.06 [28.66]; for whites: mean days [SD]: 22.18 [33.88]) than in the enhanced referral arm (mean [SD]: 62.45 [43.53], adjusted hazard ratio [HR]: 7.82; CI: 3.65-16.75, Wald chi(2): 28.02, df = 1, p <0.0001; mean [SD]: 63.46 [32.41], adjusted HR: 2.48; CI: 1.20-5.13, Wald chi(2): 6.02, df = 1, p = 0.01, respectively).

CONCLUSION

An integrated model of care is particularly effective in improving access to and participation in MH/SA treatment among black primary care patients.

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Authors+Show Affiliations

Ayalon L
School of Social Work, Bar Ilan University, Ramat Gan, Israel. ayalonl@mail.biu.ac.il
Areán PA
No affiliation info available
Linkins K
No affiliation info available
Lynch M
No affiliation info available
Estes CL
No affiliation info available

MeSH

African AmericansAgedCaliforniaDelivery of Health CareEducational StatusEuropean Continental Ancestry GroupFemaleHealth Facility MergerHealth StatusHumansMaleMental DisordersMental Health ServicesModels, OrganizationalPrimary Health CareReferral and ConsultationSex Factors

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17911367

Citation

Ayalon, Liat, et al. "Integration of Mental Health Services Into Primary Care Overcomes Ethnic Disparities in Access to Mental Health Services Between Black and White Elderly." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 15, no. 10, 2007, pp. 906-12.
Ayalon L, Areán PA, Linkins K, et al. Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. Am J Geriatr Psychiatry. 2007;15(10):906-12.
Ayalon, L., Areán, P. A., Linkins, K., Lynch, M., & Estes, C. L. (2007). Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 15(10), 906-12.
Ayalon L, et al. Integration of Mental Health Services Into Primary Care Overcomes Ethnic Disparities in Access to Mental Health Services Between Black and White Elderly. Am J Geriatr Psychiatry. 2007;15(10):906-12. PubMed PMID: 17911367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. AU - Ayalon,Liat, AU - Areán,Patricia A, AU - Linkins,Karen, AU - Lynch,Marty, AU - Estes,Carroll L, PY - 2007/10/4/pubmed PY - 2008/1/3/medline PY - 2007/10/4/entrez SP - 906 EP - 12 JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry VL - 15 IS - 10 N2 - OBJECTIVE: The authors evaluated whether the integration of mental health into primary care overcomes ethnic disparities in access to and participation in mental health (MH) and substance abuse (SA) treatment. METHODS: The authors conducted site-specific analysis of a multisite clinical trial to compare participation of black and white elderly in an integrated model of care (all MH/SA services are provided at primary care clinics) versus an enhanced referral model of care (all MH/SA services are provided at specialized MH clinics). In all, 183 elderly (56% black) diagnosed with depression (82%), anxiety (32%), and/or problem drinking (22%) were randomized. RESULTS: Blacks in the integrated arm were significantly more likely to have at least one MH/SA visit (77.5%) relative to blacks in the enhanced referral arm (22%; adjusted odds ratio [OR]: 14.13; confidence interval [CI]: 4.76-41.95, Wald chi(2): 22.75, df = 1, p <0.0001). There was no statistically significant difference between whites in the integrated treatment arm (66.6%) and whites in the enhanced referral arm (46.9%, adjusted OR: 2.98; CI: 0.98-9.06, Wald chi(2): 3.72, df = 1, p = 0.05). In the enhanced referral arm, blacks had a significantly smaller number of overall MH/SA visits (mean [SD]: 2.08 [5.28]) relative to whites (mean [SD]: 5.31 [7.76], adjusted incident rate ratio [IRR]: 2.87; CI: 1.06-7.73, Wald chi(2): 4.37, df = 1, p = 0.03). In the integrated arm, there was no statistically significant difference between blacks (mean [SD]: 3.22 [3.71]) and whites (mean [SD]: 2.75 [4.29], adjusted IRR: 0.58; CI: 0.25-1.33, Wald chi(2): 1.64, df = 1, p = 0.20). For both groups, time between baseline evaluation to first MH/SA visit was significantly shorter in the integrated treatment arm (for blacks: mean days [SD]: 31.06 [28.66]; for whites: mean days [SD]: 22.18 [33.88]) than in the enhanced referral arm (mean [SD]: 62.45 [43.53], adjusted hazard ratio [HR]: 7.82; CI: 3.65-16.75, Wald chi(2): 28.02, df = 1, p <0.0001; mean [SD]: 63.46 [32.41], adjusted HR: 2.48; CI: 1.20-5.13, Wald chi(2): 6.02, df = 1, p = 0.01, respectively). CONCLUSION: An integrated model of care is particularly effective in improving access to and participation in MH/SA treatment among black primary care patients. SN - 1064-7481 UR - https://www.unboundmedicine.com/medline/citation/17911367/Integration_of_mental_health_services_into_primary_care_overcomes_ethnic_disparities_in_access_to_mental_health_services_between_black_and_white_elderly_ L2 - https://linkinghub.elsevier.com/retrieve/pii/15/10/906 DB - PRIME DP - Unbound Medicine ER -