Collaborative care for depression in UK primary care: a randomized controlled trial
Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial. We undert...
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| Veröffentlicht in: | Psychological medicine 2008-02, Vol.38 (2), p.279-287 |
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| creator | Richards, D. A. Lovell, K. Gilbody, S. Gask, L. Torgerson, D. Barkham, M. Bland, M. Bower, P. Lankshear, A. J. Simpson, A. Fletcher, J. Escott, D. Hennessy, S. Richardson, R. |
| description | Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial.
We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9).
We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32).
Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings. |
| doi_str_mv | 10.1017/S0033291707001365 |
| format | Article |
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We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9).
We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32).
Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.</description><identifier>ISSN: 0033-2917</identifier><identifier>EISSN: 1469-8978</identifier><identifier>DOI: 10.1017/S0033291707001365</identifier><identifier>PMID: 17803837</identifier><identifier>CODEN: PSMDCO</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adult ; Adult and adolescent clinical studies ; Biological and medical sciences ; Clinical trials ; Collaboration ; Collaborative care ; complex intervention ; Cooperative Behavior ; Demography ; Depression ; Female ; Humans ; Intervention ; Male ; Medical sciences ; Mental depression ; Mental Disorders - diagnosis ; Mental Disorders - therapy ; Mental Health Services - manpower ; Mental Health Services - organization & administration ; Mood disorders ; Patient Care Team ; primary care ; Primary health care ; Primary Health Care - manpower ; Primary Health Care - methods ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; randomized controlled trial ; Randomized controlled trials ; Treatment Outcome ; United Kingdom</subject><ispartof>Psychological medicine, 2008-02, Vol.38 (2), p.279-287</ispartof><rights>Copyright © Cambridge University Press 2007</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c512t-e2e256c915ec1ea36109fc2c039824371ceec602495ed15fd2057a4756b262fb3</citedby><cites>FETCH-LOGICAL-c512t-e2e256c915ec1ea36109fc2c039824371ceec602495ed15fd2057a4756b262fb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0033291707001365/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,12846,27924,27925,30999,31000,55628</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20126580$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17803837$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Richards, D. A.</creatorcontrib><creatorcontrib>Lovell, K.</creatorcontrib><creatorcontrib>Gilbody, S.</creatorcontrib><creatorcontrib>Gask, L.</creatorcontrib><creatorcontrib>Torgerson, D.</creatorcontrib><creatorcontrib>Barkham, M.</creatorcontrib><creatorcontrib>Bland, M.</creatorcontrib><creatorcontrib>Bower, P.</creatorcontrib><creatorcontrib>Lankshear, A. J.</creatorcontrib><creatorcontrib>Simpson, A.</creatorcontrib><creatorcontrib>Fletcher, J.</creatorcontrib><creatorcontrib>Escott, D.</creatorcontrib><creatorcontrib>Hennessy, S.</creatorcontrib><creatorcontrib>Richardson, R.</creatorcontrib><title>Collaborative care for depression in UK primary care: a randomized controlled trial</title><title>Psychological medicine</title><addtitle>Psychol. Med</addtitle><description>Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial.
We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9).
We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32).
Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Biological and medical sciences</subject><subject>Clinical trials</subject><subject>Collaboration</subject><subject>Collaborative care</subject><subject>complex intervention</subject><subject>Cooperative Behavior</subject><subject>Demography</subject><subject>Depression</subject><subject>Female</subject><subject>Humans</subject><subject>Intervention</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental depression</subject><subject>Mental Disorders - diagnosis</subject><subject>Mental Disorders - therapy</subject><subject>Mental Health Services - manpower</subject><subject>Mental Health Services - organization & administration</subject><subject>Mood disorders</subject><subject>Patient Care Team</subject><subject>primary care</subject><subject>Primary health care</subject><subject>Primary Health Care - manpower</subject><subject>Primary Health Care - methods</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>randomized controlled trial</subject><subject>Randomized controlled trials</subject><subject>Treatment Outcome</subject><subject>United Kingdom</subject><issn>0033-2917</issn><issn>1469-8978</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqF0V-L1DAQAPAgireufgBfJAj6Vs0kTdL4Jouu4qEce_cc0nQqOdtmTbqifnqzbrkDRYRAAvPLMH8IeQzsBTDQL3eMCcENaKYZA6HkHbKCWpmqMbq5S1bHcHWMn5EHOV8fDdT8PjkD3TDRCL0iu00cBtfG5ObwDal3CWkfE-1wnzDnECcaJnr1ge5TGF368Vu8oo4mN3VxDD-xoz5OcyppynNOwQ0Pyb3eDRkfLfeaXL19c7l5V51_2r7fvD6vvAQ-V8iRS-UNSPSATihgpvfcM2EaXgsNHtErxmsjsQPZd5xJ7WotVcsV71uxJs9Pefcpfj1gnu0YssfSz4TxkK1mXJQj_gul5qLRjSnw6R_wOh7SVJqwhpdJc6VVQXBCPsWcE_Z2mY0FZo97sX_tpfx5siQ-tCN2tz-WRRTwbAEuezf0Zbw-5BvHGXAli12T6uRCnvH7TdylL1ZpoaVV2wt7CR93WqitvSheLMW6sU2h-4y3Lf273F9xX7FN</recordid><startdate>20080201</startdate><enddate>20080201</enddate><creator>Richards, D. A.</creator><creator>Lovell, K.</creator><creator>Gilbody, S.</creator><creator>Gask, L.</creator><creator>Torgerson, D.</creator><creator>Barkham, M.</creator><creator>Bland, M.</creator><creator>Bower, P.</creator><creator>Lankshear, A. J.</creator><creator>Simpson, A.</creator><creator>Fletcher, J.</creator><creator>Escott, D.</creator><creator>Hennessy, S.</creator><creator>Richardson, R.</creator><general>Cambridge University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7QP</scope><scope>7QR</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20080201</creationdate><title>Collaborative care for depression in UK primary care: a randomized controlled trial</title><author>Richards, D. A. ; Lovell, K. ; Gilbody, S. ; Gask, L. ; Torgerson, D. ; Barkham, M. ; Bland, M. ; Bower, P. ; Lankshear, A. J. ; Simpson, A. ; Fletcher, J. ; Escott, D. ; Hennessy, S. ; Richardson, R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c512t-e2e256c915ec1ea36109fc2c039824371ceec602495ed15fd2057a4756b262fb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Biological and medical sciences</topic><topic>Clinical trials</topic><topic>Collaboration</topic><topic>Collaborative care</topic><topic>complex intervention</topic><topic>Cooperative Behavior</topic><topic>Demography</topic><topic>Depression</topic><topic>Female</topic><topic>Humans</topic><topic>Intervention</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental depression</topic><topic>Mental Disorders - diagnosis</topic><topic>Mental Disorders - therapy</topic><topic>Mental Health Services - manpower</topic><topic>Mental Health Services - organization & administration</topic><topic>Mood disorders</topic><topic>Patient Care Team</topic><topic>primary care</topic><topic>Primary health care</topic><topic>Primary Health Care - manpower</topic><topic>Primary Health Care - methods</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>randomized controlled trial</topic><topic>Randomized controlled trials</topic><topic>Treatment Outcome</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Richards, D. A.</creatorcontrib><creatorcontrib>Lovell, K.</creatorcontrib><creatorcontrib>Gilbody, S.</creatorcontrib><creatorcontrib>Gask, L.</creatorcontrib><creatorcontrib>Torgerson, D.</creatorcontrib><creatorcontrib>Barkham, M.</creatorcontrib><creatorcontrib>Bland, M.</creatorcontrib><creatorcontrib>Bower, P.</creatorcontrib><creatorcontrib>Lankshear, A. J.</creatorcontrib><creatorcontrib>Simpson, A.</creatorcontrib><creatorcontrib>Fletcher, J.</creatorcontrib><creatorcontrib>Escott, D.</creatorcontrib><creatorcontrib>Hennessy, S.</creatorcontrib><creatorcontrib>Richardson, R.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Sociology Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Sociology Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Psychological medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Richards, D. A.</au><au>Lovell, K.</au><au>Gilbody, S.</au><au>Gask, L.</au><au>Torgerson, D.</au><au>Barkham, M.</au><au>Bland, M.</au><au>Bower, P.</au><au>Lankshear, A. J.</au><au>Simpson, A.</au><au>Fletcher, J.</au><au>Escott, D.</au><au>Hennessy, S.</au><au>Richardson, R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Collaborative care for depression in UK primary care: a randomized controlled trial</atitle><jtitle>Psychological medicine</jtitle><addtitle>Psychol. Med</addtitle><date>2008-02-01</date><risdate>2008</risdate><volume>38</volume><issue>2</issue><spage>279</spage><epage>287</epage><pages>279-287</pages><issn>0033-2917</issn><eissn>1469-8978</eissn><coden>PSMDCO</coden><abstract>Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial.
We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9).
We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32).
Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>17803837</pmid><doi>10.1017/S0033291707001365</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Psychological medicine, 2008-02, Vol.38 (2), p.279-287 |
| issn | 0033-2917 1469-8978 |
| language | eng |
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| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); Cambridge University Press Journals Complete |
| subjects | Adult Adult and adolescent clinical studies Biological and medical sciences Clinical trials Collaboration Collaborative care complex intervention Cooperative Behavior Demography Depression Female Humans Intervention Male Medical sciences Mental depression Mental Disorders - diagnosis Mental Disorders - therapy Mental Health Services - manpower Mental Health Services - organization & administration Mood disorders Patient Care Team primary care Primary health care Primary Health Care - manpower Primary Health Care - methods Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry randomized controlled trial Randomized controlled trials Treatment Outcome United Kingdom |
| title | Collaborative care for depression in UK primary care: a randomized controlled trial |
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