Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial
IMPORTANCE: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2020-08, Vol.324 (7), p.651-662 |
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| creator | Ali, Mohammed K Chwastiak, Lydia Poongothai, Subramani Emmert-Fees, Karl M. F Patel, Shivani A Anjana, Ranjit Mohan Sagar, Rajesh Shankar, Radha Sridhar, Gumpeny R Kosuri, Madhu Sosale, Aravind R Sosale, Bhavana Rao, Deepa Tandon, Nikhil Narayan, K. M. Venkat Mohan, Viswanathan |
| description | IMPORTANCE: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. INTERVENTIONS: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c |
| doi_str_mv | 10.1001/jama.2020.11747 |
| format | Article |
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F ; Patel, Shivani A ; Anjana, Ranjit Mohan ; Sagar, Rajesh ; Shankar, Radha ; Sridhar, Gumpeny R ; Kosuri, Madhu ; Sosale, Aravind R ; Sosale, Bhavana ; Rao, Deepa ; Tandon, Nikhil ; Narayan, K. M. Venkat ; Mohan, Viswanathan</creator><creatorcontrib>Ali, Mohammed K ; Chwastiak, Lydia ; Poongothai, Subramani ; Emmert-Fees, Karl M. F ; Patel, Shivani A ; Anjana, Ranjit Mohan ; Sagar, Rajesh ; Shankar, Radha ; Sridhar, Gumpeny R ; Kosuri, Madhu ; Sosale, Aravind R ; Sosale, Bhavana ; Rao, Deepa ; Tandon, Nikhil ; Narayan, K. M. Venkat ; Mohan, Viswanathan ; INDEPENDENT Study Group ; for the INDEPENDENT Study Group</creatorcontrib><description>IMPORTANCE: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. INTERVENTIONS: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. RESULTS: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). CONCLUSIONS AND RELEVANCE: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02022111</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2020.11747</identifier><identifier>PMID: 32809002</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Aged ; Blood Pressure ; Cardiovascular diseases ; Cholesterol ; Cholesterol, LDL - blood ; Clinical trials ; Collaboration ; Cooperative Behavior ; Depression - complications ; Depression - therapy ; Developing Countries ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - therapy ; Electronic health records ; Electronic medical records ; Female ; Glycated Hemoglobin A - analysis ; Health services ; Hemoglobin ; Humans ; Hypoglycemia ; India ; Intervention ; Low density lipoprotein ; Male ; Mental depression ; Mental health ; Middle Aged ; Original Investigation ; Patient Care Team ; Patients ; Questionnaires ; Reduction ; Self-Management ; Signs and symptoms ; Socioeconomic Factors ; Statistical analysis ; Statistical significance</subject><ispartof>JAMA : the journal of the American Medical Association, 2020-08, Vol.324 (7), p.651-662</ispartof><rights>Copyright American Medical Association Aug 18, 2020</rights><rights>Copyright 2020 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a353t-b4a702fa1598158ca769da92f60693b6fcaf3925a8af7202e8b6907c20c297483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2020.11747$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.11747$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32809002$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ali, Mohammed K</creatorcontrib><creatorcontrib>Chwastiak, Lydia</creatorcontrib><creatorcontrib>Poongothai, Subramani</creatorcontrib><creatorcontrib>Emmert-Fees, Karl M. F</creatorcontrib><creatorcontrib>Patel, Shivani A</creatorcontrib><creatorcontrib>Anjana, Ranjit Mohan</creatorcontrib><creatorcontrib>Sagar, Rajesh</creatorcontrib><creatorcontrib>Shankar, Radha</creatorcontrib><creatorcontrib>Sridhar, Gumpeny R</creatorcontrib><creatorcontrib>Kosuri, Madhu</creatorcontrib><creatorcontrib>Sosale, Aravind R</creatorcontrib><creatorcontrib>Sosale, Bhavana</creatorcontrib><creatorcontrib>Rao, Deepa</creatorcontrib><creatorcontrib>Tandon, Nikhil</creatorcontrib><creatorcontrib>Narayan, K. M. Venkat</creatorcontrib><creatorcontrib>Mohan, Viswanathan</creatorcontrib><creatorcontrib>INDEPENDENT Study Group</creatorcontrib><creatorcontrib>for the INDEPENDENT Study Group</creatorcontrib><title>Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>IMPORTANCE: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. INTERVENTIONS: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. RESULTS: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). CONCLUSIONS AND RELEVANCE: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02022111</description><subject>Adult</subject><subject>Aged</subject><subject>Blood Pressure</subject><subject>Cardiovascular diseases</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL - blood</subject><subject>Clinical trials</subject><subject>Collaboration</subject><subject>Cooperative Behavior</subject><subject>Depression - complications</subject><subject>Depression - therapy</subject><subject>Developing Countries</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Female</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Health services</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>India</subject><subject>Intervention</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Mental depression</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Original Investigation</subject><subject>Patient Care Team</subject><subject>Patients</subject><subject>Questionnaires</subject><subject>Reduction</subject><subject>Self-Management</subject><subject>Signs and symptoms</subject><subject>Socioeconomic Factors</subject><subject>Statistical analysis</subject><subject>Statistical significance</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkl1v0zAUhiMEYmVwjcQFssQNF-vmj3xygTTSslUao2JFXFonidN6cuxiJ5PKT-XXcLJuFZALR9Z5ztfrN4peM3rKKGVnt9DBKaccryyLsyfRhCUin4qkyJ9GE0qLfJrFeXwUvQjhluLHRPY8OhI8pwWlfBL9nretqnviWgKkdMZA5Tz0-k6RErwiX1yjDHGWzNTWqxDGwM2u2_auCwRsQy7MroZeNeRSdW5tXKXtCflknGvIckwYvDq5B2-UHzpSbpxRoVfeGXLeObsmS-ymbB_ID91vDm2w45g001CpXgWiLVnYRsMHstoosriezZdzPK5X5BtyrtO_cITSaKtrMGTlNZiX0bMWTFCvHv7H0ffP81V5Ob36erEoz6-mIBLRT6sYMspbYKgZS_IasrRooOBtStNCVGlbQysKnkAObYZSq7xKC5rVnNa8QHHFcfRxX3c7VJ1qalzGg5FbrzvwO-lAy38jVm_k2t3JLMYB4gwLvH8o4N3PAdWRnQ61wrewyg1BcuRYntOEIfruP_TWDd7ieiNV4DQiFUid7anauxC8ag_DMCpH38jRN3L0jbz3DWa8_XuHA_9oFATe7IEx8THKUao4TcUfYePJTQ</recordid><startdate>20200818</startdate><enddate>20200818</enddate><creator>Ali, Mohammed K</creator><creator>Chwastiak, Lydia</creator><creator>Poongothai, Subramani</creator><creator>Emmert-Fees, Karl M. F</creator><creator>Patel, Shivani A</creator><creator>Anjana, Ranjit Mohan</creator><creator>Sagar, Rajesh</creator><creator>Shankar, Radha</creator><creator>Sridhar, Gumpeny R</creator><creator>Kosuri, Madhu</creator><creator>Sosale, Aravind R</creator><creator>Sosale, Bhavana</creator><creator>Rao, Deepa</creator><creator>Tandon, Nikhil</creator><creator>Narayan, K. M. 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F</au><au>Patel, Shivani A</au><au>Anjana, Ranjit Mohan</au><au>Sagar, Rajesh</au><au>Shankar, Radha</au><au>Sridhar, Gumpeny R</au><au>Kosuri, Madhu</au><au>Sosale, Aravind R</au><au>Sosale, Bhavana</au><au>Rao, Deepa</au><au>Tandon, Nikhil</au><au>Narayan, K. M. Venkat</au><au>Mohan, Viswanathan</au><aucorp>INDEPENDENT Study Group</aucorp><aucorp>for the INDEPENDENT Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2020-08-18</date><risdate>2020</risdate><volume>324</volume><issue>7</issue><spage>651</spage><epage>662</epage><pages>651-662</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><abstract>IMPORTANCE: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. INTERVENTIONS: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. RESULTS: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). CONCLUSIONS AND RELEVANCE: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02022111</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>32809002</pmid><doi>10.1001/jama.2020.11747</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2020-08, Vol.324 (7), p.651-662 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7435347 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Adult Aged Blood Pressure Cardiovascular diseases Cholesterol Cholesterol, LDL - blood Clinical trials Collaboration Cooperative Behavior Depression - complications Depression - therapy Developing Countries Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - therapy Electronic health records Electronic medical records Female Glycated Hemoglobin A - analysis Health services Hemoglobin Humans Hypoglycemia India Intervention Low density lipoprotein Male Mental depression Mental health Middle Aged Original Investigation Patient Care Team Patients Questionnaires Reduction Self-Management Signs and symptoms Socioeconomic Factors Statistical analysis Statistical significance |
| title | Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T09%3A08%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20a%20Collaborative%20Care%20Model%20on%20Depressive%20Symptoms%20and%20Glycated%20Hemoglobin,%20Blood%20Pressure,%20and%20Serum%20Cholesterol%20Among%20Patients%20With%20Depression%20and%20Diabetes%20in%20India:%20The%20INDEPENDENT%20Randomized%20Clinical%20Trial&rft.jtitle=JAMA%20:%20the%20journal%20of%20the%20American%20Medical%20Association&rft.au=Ali,%20Mohammed%20K&rft.aucorp=INDEPENDENT%20Study%20Group&rft.date=2020-08-18&rft.volume=324&rft.issue=7&rft.spage=651&rft.epage=662&rft.pages=651-662&rft.issn=0098-7484&rft.eissn=1538-3598&rft_id=info:doi/10.1001/jama.2020.11747&rft_dat=%3Cproquest_pubme%3E2435188051%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2439483363&rft_id=info:pmid/32809002&rft_ama_id=2769466&rfr_iscdi=true |