Disparities in the Treatment Engagement Cascade of Collaborative Care for Depression in a Pragmatic Implementation Study

OBJECTIVE: The aim of this study was to examine disparities in treatment engagement in a pragmatic implementation trial of the collaborative care model (CoCM) for depression and anxiety. METHODS: This was a pragmatic, type 2 effectiveness-implementation, randomized rollout study of CoCM. Eleven primary care clinics were randomly assigned an intervention start date and engaged in a 1-year implementation and 1-year sustainment period. Data were extracted from electronic health records of primary care patients attending an associated clinic during the study period (October 1, 2018-January 31, 2023). Treatment engagement cascade steps were screened, referred, assessed, engaged, and completed. Logistic regression models identified demographic predictors (gender, race-ethnicity, age, and insurance status) at each step. RESULTS: A total of 117,949 primary care patients were included (59.3% were female, 78.9% were age