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Collaborative care for depression in UK primary care: a randomised controlled trial

Richards, D.A., Lovell, K., Gilbody, S., Gask, L., Torgerson, D., Barkham, M., Bland, M., Bower, P., Lankshear, Annette Jean, Simpson, A., Fletcher, J., Escott, D., Hennessy, S. and Richardson, R. 2007. Collaborative care for depression in UK primary care: a randomised controlled trial. Psychological Medicine 38 , pp. 279-287. 10.1017/S0033291707001365

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Abstract

Background 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. Method 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). Results 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). Conclusions 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Uncontrolled Keywords: Collaborative care; complex intervention; depression; primary care; randomized controlled trial
Additional Information: Publisher’s copyright requirements: “All contributors retain the right to post the definitive version of the contribution as published at Cambridge Journals Online (in PDF or HTML form) in the Institutional Repository of the institution in which they worked at the time the paper was first submitted, or (for appropriate journals) in PubMed Central or UK PubMed Central, no sooner than one year after first publication of the paper in the journal, subject to file availability and provided the posting includes a prominent statement of the full bibliographical details, a copyright notice in the name of the copyright holder (Cambridge University Press or the sponsoring Society, as appropriate), and a link to the online edition of the journal at Cambridge Journals Online. Inclusion of this definitive version after one year in Institutional Repositories outside of the institution in which the contributor worked at the time the paper was first submitted will be subject to the additional permission of Cambridge University Press (not to be unreasonably withheld). See: http://journals.cambridge.org/action/forAuthors?page=copyright
Publisher: Cambridge University Press
ISSN: 1469-8978
Last Modified: 04 Jun 2017 01:36
URI: http://orca.cardiff.ac.uk/id/eprint/802

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