December 29, 2010Open Access
Collaborative Care for Patients with Depression and Chronic Illnesses
Key Result
Collaborative care management improved glycated hemoglobin levels by 0.58% and reduced LDL cholesterol levels by 6.9 mg/dl compared to usual care, with significant improvements in systolic blood pressure and depression scores.
Study Design
Type
RCT (n=214)
Randomization
Permuted block randomization
Blinding
Single-blind
Multicenter
Yes
Structured PICO
Does a nurse-led collaborative care intervention improve control of medical disease and depression in patients with poorly controlled diabetes, coronary heart disease, or both and coexisting depression?
P
Population
214 participants with poorly controlled diabetes, coronary heart disease, or both and coexisting depression
I
Intervention
Guideline-based, collaborative care management provided by a medically supervised nurse working with the patient's primary care physician
C
Comparator
Usual care (advised to consult with their primary care physician to receive care)
O
Outcome
Multivariate primary outcome with simultaneous modeling of four separate 12-month outcomes: Symptom Checklist-20 (SCL-20) depression score, glycated hemoglobin level, systolic blood pressure, and LDL cholesterol levelcomposite
A primary care-based collaborative care intervention significantly improved both depression and medical disease control (HbA1c, LDL, and systolic blood pressure) in patients with coexisting depression and poorly controlled diabetes or coronary heart disease.
Main Result
Effect estimate: null (95% CI null)
p-value: p=<0.001
Limitations
- Study conducted within one health plan, potentially limiting generalizability.
- Lack of a control group receiving the same number of visits as the intervention group.
Abstract
As compared with usual care, an intervention involving nurses who provided guideline-based, patient-centered management of depression and chronic disease significantly improved control of medical disease and depression. (Funded by the National Institute of Mental Health; ClinicalTrials.gov number, NCT00468676.).
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Authors
Wayne Katon
Dartmouth College
E
Elizabeth Lin
Centre for Addiction and Mental Health
M
Michael Von Korff
University of North Carolina at Chapel Hill
Journals
New England Journal of Medicine
Actions
Institutions
University of Washington
References and Citations
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