Patient Priorities and Community Context: Navigation for Disadvantaged Women with Depression

Project Profile

Title: Patient Priorities and Community Context: Navigation for Disadvantaged Women with Depression
Project Period : 07/01/12 - 06/30/17
Sponsor: PCORI
Role: Co-Investigator
Principal Investigator: Ellen Poleschuck & Catherine Cerulli

Socioeconomically disadvantaged (SD) women are at elevated risk for depression and poor treatment engagement and outcomes.  Many use Obstetric/Gynecology (Ob/Gyn) practices as their primary resource for physical and mental health care.  Yet their depression most often goes unrecognized and unaddressed within Ob/Gyn, and when addressed, engagement and outcomes are poor.  Patients at the greatest risk include those with multiple biomedical and psychosocial problems, trauma exposure, health care barriers, and experiencing a lack of empowerment over one’s own health.  Through our preliminary research and work with our community advisory board (CAB) consisting of patient and provider partners, we concluded many SD patients do not feel conventional depression treatments meet their needs. SD patients require interventions with outreach and support that address the problems of most concern to them.  

This clinical trial will compare patient preference-based navigation, Personalized Support for Progress (PSP), to Enhanced Screening and Referral (ESR), both recommended by our CAB.  Specifically we will: Aim 1. Determine satisfaction among patients receiving PSP and ESR. Aim 2. Compare outcomes of PSP to ESR for depression and quality of life (QOL). Aim 3. Identify which patients are particularly likely to benefit from PSP compared to ESR.

We will target 200 Ob/Gyn patients in a practice consisting primarily of SD patients.  To be included, patients must: have current depression, be an active Ob/Gyn patient at the identified practice, be 18 years of age or older, and not currently receiving navigation or case management. Clinic patients will be screened for behavioral health and social needs while waiting for their appointments.  Patients who are eligible and agree will be assigned to ESR or PSP.  In ESR, patients will receive a list of the concerns they identified and offered referrals as needed.  In PSP, patients will meet with a navigator to prioritize their concerns, develop a personalized care plan based on these concerns, and execute the plan over 4 months.  PSP navigators are lay people trained in outreach, care planning, advocacy, and support from the same neighborhoods as the patients.  Patient will be evaluated for change before starting the trial, immediately following the intervention, and at 3 and 6-months follow-up. Statistical analyses will determine if there are significant differences in satisfaction and in how much patients change between the two intervention groups. Interviews will also be used to assess patient satisfaction.

Depression and QOL are the outcomes identified as critical by patient partners. Our long-term objective is to establish patient-centered, effective interventions that can be used in multiple contexts to improve QOL and depression for SD patients.