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

Published online by Cambridge University Press:  06 September 2007

D. A. Richards ,
K. Lovell ,
S. Gilbody ,
L. Gask ,
D. Torgerson ,
M. Barkham ,
M. Bland ,
P. Bower ,
A. J. Lankshear  and
A. Simpson
...Show all authors
D. A. Richards*
Affiliation:
Department of Health Sciences, University of York, UK
K. Lovell
Affiliation:
Department of Nursing, Midwifery and Social Work, University of Manchester, UK
S. Gilbody
Affiliation:
Department of Health Sciences, University of York, UK
L. Gask
Affiliation:
National Primary Care Research and Development Centre, University of Manchester, UK
D. Torgerson
Affiliation:
Department of Health Sciences, University of York, UK
M. Barkham
Affiliation:
Centre for Psychotherapy Services Research, University of Sheffield, UK
M. Bland
Affiliation:
Department of Health Sciences, University of York, UK
P. Bower
Affiliation:
National Primary Care Research and Development Centre, University of Manchester, UK
A. J. Lankshear
Affiliation:
School of Nursing and Midwifery Studies, University of Cardiff, UK
A. Simpson
Affiliation:
Department of Health Sciences, University of York, UK
J. Fletcher
Affiliation:
Department of Nursing, Midwifery and Social Work, University of Manchester, UK
D. Escott
Affiliation:
Department of Nursing, Midwifery and Social Work, University of Manchester, UK
S. Hennessy
Affiliation:
Department of Health Sciences, University of York, UK
R. Richardson
Affiliation:
Department of Health Sciences, University of York, UK
*
*Address for correspondence: Professor D. A. Richards, Department of Health Sciences, Seebohm Rowntree Building, University of York, University Road, Heslington, York, North Yorkshire, United Kingdom. (Email: [email protected])
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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.

Keywords

Collaborative carecomplex interventiondepressionprimary carerandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 2 , February 2008 , pp. 279 - 287
Copyright
Copyright © Cambridge University Press 2007

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