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

D. A. Richards; K. Lovell; S. Gilbody; L. Gask; D. Torgerson; M. Barkham; M. Bland; P. Bower; A. J. Lankshear; A. Simpson; J. Fletcher; D. Escott; S. Hennessy; R. Richardson

doi:10.1017/S0033291707001365

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

D. A. Richards, K. Lovell, S. Gilbody, L. Gask, D. Torgerson, M. Barkham, M. Bland, P. Bower, A. J. Lankshear, A. Simpson, J. Fletcher, D. Escott, S. Hennessy, R. Richardson

Research output: Contribution to journal › Article › peer-review

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 % Cl -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.

Original language	English
Pages (from-to)	279-287
Number of pages	9
Journal	Psychological Medicine
Volume	38
Issue number	2
DOIs	https://doi.org/10.1017/S0033291707001365
Publication status	Published - Feb 2008

Keywords

collaborative care
complex intervention
depression
primary care
randomized controlled trial
ANTIDEPRESSANT MEDICATION
BEHAVIORAL ACTIVATION
OLDER-PEOPLE
INTERVENTIONS
HEALTH
MANAGEMENT
OUTCOMES
METAANALYSIS
ADHERENCE
IMPROVE

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@article{d427332fe9dc4ec9822803da949994a7,

title = "Collaborative care for depression in UK primary care: a randomized controlled trial",

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 % Cl -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.",

keywords = "collaborative care, complex intervention, depression, primary care, randomized controlled trial, ANTIDEPRESSANT MEDICATION, BEHAVIORAL ACTIVATION, OLDER-PEOPLE, INTERVENTIONS, HEALTH, MANAGEMENT, OUTCOMES, METAANALYSIS, ADHERENCE, IMPROVE",

author = "Richards, {D. A.} and K. Lovell and S. Gilbody and L. Gask and D. Torgerson and M. Barkham and M. Bland and P. Bower and Lankshear, {A. J.} and A. Simpson and J. Fletcher and D. Escott and S. Hennessy and R. Richardson",

year = "2008",

month = feb,

doi = "10.1017/S0033291707001365",

language = "English",

volume = "38",

pages = "279--287",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

number = "2",

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T1 - Collaborative care for depression in UK primary care

T2 - a randomized controlled trial

AU - Richards, D. A.

AU - Lovell, K.

AU - Gilbody, S.

AU - Gask, L.

AU - Torgerson, D.

AU - Barkham, M.

AU - Bland, M.

AU - Bower, P.

AU - Lankshear, A. J.

AU - Simpson, A.

AU - Fletcher, J.

AU - Escott, D.

AU - Hennessy, S.

AU - Richardson, R.

PY - 2008/2

Y1 - 2008/2

N2 - 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 % Cl -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.

AB - 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 % Cl -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.

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KW - primary care

KW - randomized controlled trial

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KW - BEHAVIORAL ACTIVATION

KW - OLDER-PEOPLE

KW - INTERVENTIONS

KW - HEALTH

KW - MANAGEMENT

KW - OUTCOMES

KW - METAANALYSIS

KW - ADHERENCE

KW - IMPROVE

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U2 - 10.1017/S0033291707001365

DO - 10.1017/S0033291707001365

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VL - 38

SP - 279

EP - 287

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 2

ER -

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

Abstract

Keywords

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