Intervention impact on depression product appraisal and purchasing behavior by employers: a randomized trial

BMC Health Services Research

Stanley Xu³  Donna Marshall¹  Kathryn M Rost² 

[1] Colorado Business Group on Health, 12640 West Cedar Avenue, Suite A, Lakewood, CO 80228, USA;Department of Mental Health Law and Policy, College of Behavioral and Community Studies, University of South Florida, 13301 Bruce B. Downs Boulevard, Tampa, FL 33612, USA;Department of Biostatistics and Informatics, School of Public Health, University of Colorado Denver, Denver, USA

关键词: Randomized trial;    Implementation science;    Academic detailing;    Return on investment;    Employers;    Depression care management;   

Others  :  1126235
DOI  :  10.1186/1472-6963-14-426

 received in 2014-05-29, accepted in 2014-09-16,  发布年份 2014

【 摘 要 】

Background

Employers can purchase high quality depression products that provide the type, intensity and duration of depression care management shown to improve work outcomes sufficiently for many employers to achieve a return on investment. The purpose of this randomized controlled trial was to test an intervention to encourage employers to purchase a high quality depression product for their workforce.

Methods

Twenty nine organizations recruited senior health benefit professional members representing public or private employers who had not yet purchased a depression product for all 100+ workers in their company. The research team used randomization blocked by company size to assign eligible employers to: (1) a presentation encouraging employers to purchase a high quality depression product accompanied by a scientifically-derived return on investment estimate, or (2) a presentation encouraging employers to work with their most subscribed health plan to improve depression treatment quality indicators. Two hundred ninety three employers (82.3% of 356) completed baseline data immediately before learning that 140 employers had been randomized to the evidence-based (EB) depression product presentation and 153 had been randomized to the usual care (UC) depression treatment quality indicator presentation. Analysis of 250 (85.3% of 293) employers who completed web-based interviews at 12 and/or 24 months was conducted to determine presentation impact on depression product appraisal and purchasing behavior.

Results

The intervention had no impact on depression product appraisal in 232 subjects (F = 2.36, p = .07) or depression product purchasing (chisquare = 1.82, p = .44) in 250 subjects. Depression product appraisal increased in companies with greater health benefit generosity whose benefit professionals were male. Depression product purchasing behavior increased in small companies compared to large companies, companies who knew a vendor that sold depression products at baseline, companies with greater health benefit risk taking, and companies with less politicalization of health care benefit decision making.

Conclusions

Policy makers need to build innovative bridges to the employer community to convince them to purchase evidence-based benefits, even when benefits offer potential financial savings.

Trial registration

Clinical Trials Registration Number: NCT01013220.

【 授权许可】

   
2014 Rost et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Pincus HA, Houtsinger JK, Bachman J, Keyser D: Depression in primary care: bringing behavioral health care into the mainstream. Health Aff 2005, 24:271-276.
• [2]Gilbody S, Bower P, Fletcher J, Richards D, Sutton A: Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006, 166:2314-2321.
• [3]Bower P, Gilbody S, Richards D, Fletcher J, Sutton A: Collaborative care for depression in primary care: making sense of a complex intervention: systematic review and meta-regression. Br J Psychiatry 2006, 189:484-493.
• [4]Dietrich AJ, Oxman TE, Williams JW Jr, Schulberg HC, Bruce M, Lee PW, Barry S, Raue P, Lefever J, Jen M, Rost K, Kroenke K, Gerrity M, Nutting P: Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. Br Med J 2004, 329:602-605.
• [5]Pincus HA: Depression and primary care: drowning in the mainstream or left on the banks? J Manag Care Pharm 2006, 12:3-9.
• [6]van Steenbergen-Weijenburg KM, van der Feltz-Cornelis CM, Horn EK: Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care: a systematic review. BMC Health Serv Res 2010, 10:19-28. BioMed Central Full Text
• [7]Rost K, Pyne JM, Dickinson LM, LoSasso AT: Cost-effectiveness of enhancing primary care depression management on an ongoing basis. Ann Fam Med 2005, 3:7-14.
• [8]Crimmel BL, Sommers JP: Employer-sponsored health insurance for state and local governments. In Statistical Brief #223. Edited by Census Division. Rockville, MD: Agency for Healthcare Research and Quality; 2006. http://www.meps.ahrq.gov/mepsweb/data_files/ webcite publications/st223/stat223.pdf. Last accessed 9/20/14
• [9]Birnbaum HG, Kessler RC, Kelley D, Ben-Hamadi R, Joish VN, Greenberg PE: Employer burden of mild, moderate and severe major depressive disorder: mental health services utilization and costs and work performance. Depress Anxiety 2010, 27:78-89.
• [10]Stewart WF, Ricci JA, Chee E, Hahn S, Morganstein D: Cost of lost productive work time among US workers with depression. J Am Med Assoc 2003, 289:3135-3144.
• [11]Kessler RC, Akiskal HS, Ames M, Birnbaum H, Greenberg P, Hirschfeld RM, Jin R, Merikangas KR, Simon GE, Wang PS: Prevalence and effects of mood disorders on work performance in a nationally representative sample of US workers. Am J Psychiatry 2006, 163:1561-1568.
• [12]Rost KM, Smith JL, Dickinson M: The effect of improving primary care depression management on employee absenteeism and productivity: a randomized trial. Med Care 2004, 42:1202-1210.
• [13]Lo Sasso AT, Rost KM, Beck A: Modeling the impact of enhanced depression treatment on workplace functioning and costs: a cost-benefit approach. Med Care 2006, 44:352-358.
• [14]Rost K, Marshall D, Shearer B, Dietrich A: Depression care management: can employers purchase improved outcomes? Depress Res Treat 2011, 2011:942519.
• [15]Schoenbaum M, Kelleher L, Lave JR, Green S, Keyser D, Pincus H: Exploratory evidence on the market for effective depression care in Pittsburgh. Psychiatr Serv 2004, 55:392-395.
• [16]Rost K, Marshall D: Marketing depression care management to employers: design of a randomized controlled trial. Implement Sci 2010, 5:22. BioMed Central Full Text
• [17]Rost K: Depression Management in the Workplace Interventions. http://www.caremanagementfordepression.org/dmw/intervention.html webcite. Last accessed 8/26/14.
• [18]Soumerai SB, Avorn J: Principles of educational outreach (‘academic detailing’) to improve clinical decision making. J Am Med Assoc 1990, 263:549-556.
• [19]Lu CY, Ross-Degnan D, Soumerai SB, Pearson SA: Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature - 2001–2007. BMC Health Serv Res 2008, 8:75. BioMed Central Full Text
• [20]Rost K, Nutting P, Smith JL, Elliott CE, Dickinson LM: Managing depression as a chronic disease: A randomised trial of ongoing treatment in primary care. British Medical Journal 2002, 325:934-939.
• [21]Rost K: Calculator to estimate return on investment with high quality depression products. http://www.caremanagementfordepression.org/newCalc/page1.html webcite. Last accessed 8/26/14.
• [22]Rosenthal MB, Landon BE, Normand SL, Frank RG, Ahmad TS, Epstein AM: Employers’ use of value-based purchasing strategies. J Am Med Assoc 2007, 298:2281-2288.
• [23]Maio V, Hartmann CW, Goldfarb NI, Roumm AR, Nash DB: Are employers pursuing value-based purchasing? Benefits Q 2005, 21:20-29.
• [24]Hibbard JH, Jewett JJ, Legnini MW, Tusler M: Choosing a health plan: do large employers use the data? Health Aff 1997, 16:172-180.
• [25]Rost K, Papadopoulos A, Wang S, Marshall D: Understanding the “Black Box” of Employer Decisions about Health Insurance Benefits: the Case of Depression Products. Risks 2013, 1:34.42.
• [26]Rost K: Depression Management in the Workplace instrumentation. http://www.caremanagementfordepression.org/dmw/instrumentation/html webcite. Last accessed 8/26/14.
• [27]Rost K, Marshall D, Wang S, Xu S, Hagman B: Purchaser preferences in strategies to improve depression treatment. Clin Exp Med Sci 2013, 1:161-175.
• [28]Molfenter T, Kimn JS, Quanbeck A, Patel-Porter T, Starr S, McCarty D: Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial. Implement Sci 2013, 10:50.
• [29]Mattke S, Liu H, Caloyeras JP, Huang CY, Van Busum KR, Khodyakov D, Shier D: Workplace wellness programs study: final report. RAND Corporation; 2013. RR-254-DOL. Available at http://www.rand.org/t/RR254 webcite. Accessed 5/28/14.
• [30]Archelle on Health: The Death of Disease Management (finally). http://www.archelleonhealth.com/2012/…/death-of-disease-mnagement-finally.html webcite. Accessed 528/14.