TY  - JOUR
PY  - 2020//
TI  - Provider contributions to disparities in mental health care
JO  - Psychiatric services
A1  - Merced, Kritzia
A1  - Imel, Zac E.
A1  - Baldwin, Scott A.
A1  - Fischer, Heidi
A1  - Yoon, Tae
A1  - Stewart, Christine
A1  - Simon, Greg
A1  - Ahmedani, Brian
A1  - Beck, Arne
A1  - Daida, Yihe
A1  - Hubley, Sam
A1  - Rossom, Rebecca
A1  - Waitzfelder, Beth
A1  - Zeber, John E.
A1  - Coleman, Karen J.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - OBJECTIVE: Disparities in diagnosis of mental health problems and in access to treatment among racial-ethnic groups are apparent across different behavioral conditions, particularly in the quality of treatment for depression. This study aimed to determine how much disparities differ across providers. <br><br>METHODS: Bayesian mixed-effects models were used to estimate whether disparities in patient adherence to antidepressant medication (N=331,776) or psychotherapy (N=275,095) were associated with specific providers. Models also tested whether providers who achieved greater adherence to treatment, on average, among non-Hispanic white patients than among patients from racial-ethnic minority groups attained lower disparities and whether the percentage of patients from racial-ethnic minority groups in a provider caseload was associated with disparities. <br><br>RESULTS: Disparities in adherence to both antidepressant medication and psychotherapy were associated with the provider. Provider performance with non-Hispanic white patients was negatively correlated with provider-specific disparities in adherence to psychotherapy but not to antidepressants. A higher proportion of patients from racial-ethnic minority groups in a provider's caseload was associated with lower adherence among non-Hispanic white patients, lower disparities in adherence to psychotherapy, and greater disparities in adherence to antidepressant medication. <br><br>CONCLUSIONS: Adherence to depression treatment among a provider's patients from racial-ethnic minority groups was related to adherence among that provider's non-Hispanic white patients, but evidence also suggested provider-specific disparities. Efforts among providers to decrease disparities might focus on improving the general skill of providers who treat more patients from racial-ethnic minority groups as well as offering culturally based training to providers with notable disparities.<p />  <p>Language: en</p>
LA  - en
SN  - 1075-2730
UR  - http://dx.doi.org/10.1176/appi.ps.201800500
ID  - ref1
ER  -