Paired Perspectives on Depressio

Project Contact: Nancy Morrow-Howell, nancymh@wustl.edu; Phone: 314-935-6762

Project Update as of 3/08/2007:
Stage: Preparation for dissemination of findings and work on next iteration of this pilot work is under development.

Description: CLTC clients with depression (n=50) and their matched case managers (n=50) were selected from the Missouri Division of Senior and Disability Services (DSDS) units that participated in the Burden of Depression Study. We sought the consent of those with depression for an in-home semi-structured interview that focuses on depression as a priority treatment issue; preferences regarding treatments and outcomes; and obstacles/barriers faced in securing treatment. We developed our paired-assessment in consultation with the RMC Stakeholder Preference Assessment Team, led by Dr. Shumway. At the end of the interview, we will seek client permission to interview the client’s DSDS case manager with a parallel set of questions, focusing on the case manager’s perception of the priority of treating depression among other concerns as well as preferences for treatment and outcomes. We also solicited the case manager’s perception of the feasibility and acceptability of various treatment approaches and adjunct services that would be necessary for this treatment to be effective (issues of polypharmacy; medication monitoring, payment for prescriptions; transportation, etc.).

This project addressed a concern that emerged repeatedly in our prior focus groups with CLTC case managers: that many clients do not share the case manager’s perspective that depression is a concern and may require some treatment.

From this data we were able to characterize (1) the treatment priorities and preferences of clients as a group, (2) the treatment priorities and preferences of case managers as a group, and (3) the extent to which client-providers pairs have convergent or divergent priorities. To analyze the paired data, we followed the example of the cutting edge work of Fischer, Shumway, and Owen, which includes magnitude-estimation-preferences-weight and Kendall’s rank order correlation to evaluate pairwise agreement regarding priorities. Both methods yield agreement scores, but the magnitude-estimation-preferences-weighting captures not only the order of importance but also the relative magnitude of importance. The extent of agreement between these two stakeholder groups was informative in developing treatment and referral strategies which may differ depending on whether both clients and case managers rate depression treatment as a high priority, both rate it as low priority, or there is discrepancy between them. For example, when there was agreement that treatment is a high priority, working with the primary care doctor may be most efficient and effective; when there was agreement on its low priority, monitoring and periodic reassessment was appropriate.

Progress in Year 1, 9/22/05-7/31/05: Major accomplishments for the first year of funding included hiring a part-time project coordinator, finalizing the study instrumentation, and developing recruitment materials (i.e., invitation letter to previous participants of the Burden of Depression Study.) The semi-structure interviews were revised in order to incorporate feedback from the consultant, Martha Shumway. These revisions have been approved by Washington University’s Internal Review Board. The materials were reviewed by the State of Missouri’s Internal Review Board for Human Subjects.

Plans for Year 2, 8/01/05-7/31/06: Data collection plans for 2005 were reviewed with the Missouri DSDS Regional Manager for St. Louis. The goals for this time-frame included conducting the semi-structured interviews, data analysis, and dissemination of findings. Training and pilot interviewing will began June 2005. All interviews were completed and staff time was dedicated to data entry, analysis and dissemination.

Community long-term care clients’ beliefs about depression: A qualitative study to inform treatment development; Gerontological Society of America, Dallas, TX; November 17-20, 2006; Leslie Hasche, Deanna Davidson, Nancy Morrow-Howell, Enola Proctor, Mike Nickel, & Grace Snell.

Stakeholder preferences assessment to inform treatment development of community long-term care elderly clients; Society for Social Work and Research, San Francisco, CA; January 11-14, 2007; Leslie Hasche, Deanna Davidson, Nancy Morrow-Howell, Enola Proctor, Martha Shumway, Mike Nickel, & Grace Snell.

This work has evolved into a new iteration of piloting that is intended to lead to an NIH grant proposal:

Stakeholder Perspectives of Collaborative Care in CLTC

Nancy Morrow-Howell, PhD, Enola Proctor, PhD, Martha Shumway, PhD, Co-PIs; Brian Carpenter, PhD, Sue Pfefferle, PhD, Paul Sacco, MSW, Investigators.