Rural primary care practices encounter greater challenges than their urban counterparts when they try to improve the quality of care their depressed patients receive. Rather than assume that "one size fits all," investigators need to evaluate whether depression treatment quality intervention has comparable effectiveness in improving outcomes in rural and urban patients. This project will explore whether rural populations achieve outcomes with intervention comparable to their urban counterparts, and whether differences are explained by treatment mediators (e.g., evidence-based care) or psychosocial mediators (e.g., stressful life events and social support). This project will test prespecified hypotheses by conducting secondary analyses of an randomized control trial (RCT) known as the Quality Enhancement for Strategic Teaming (QuEST) study, consisting of a consecutively sampled cohort of 479 depressed primary care patients recruited from 12 practices in 10 states (Colorado, Michigan, Minnesota, New Jersey, North Dakota, North Carolina, Oklahoma, Oregon, Virginia, and Wisconsin); 160 of these depressed primary care patients are recruited from practices in non-MSA counties in four states (Minnesota, North Dakota, Oregon, and Wisconsin). The study's strength is its ability to extend preliminary explorations the research team has conducted to a definitive study of differential intervention effectiveness, identifying mediators that explain any differential effects of the intervention on outcomes. These mediators can then be targeted for intervention refinement before these initiatives are disseminated to rural populations. This project will produce a manuscript for peer-reviewed publication, a working paper, a research summary, a brochure, and a conference/grand rounds presentation.

Publications

• Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
  Journal Article
  WICHE Center for Rural Mental Health Research
  Date: 09/2006
  Is there a differential impact of enhanced depression care on patient outcomes in rural vs. urban primary care settings? Differences may be mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that care for depression improved mental health for urban populations, but not rural patients.