Collaborative Care for Patients with Depression and Chronic Illnesses

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Depression and chronic illnesses (diabetes and coronary heart disease) (n=214). Intervention: Collaborative care management vs. Usual care. Primary outcome: Improvement in glycated hemoglobin, LDL cholesterol, systolic blood pressure, and SCL-20 depression scores (null, 95% CI null, p=<0.001).

Wayne Katon; Elizabeth Lin; Michael Von Korff; Paul Ciechanowski; Evette Ludman; Bessie A. Young; Do Peterson; Carolyn M. Rutter; Mary McGregor; David K. McCulloch

doi:10.1056/nejmoa1003955

December 29, 2010New England Journal of MedicineOpen Access

Collaborative Care for Patients with Depression and Chronic Illnesses

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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.

Why the study?

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?

Key Points

To evaluate the effectiveness of a nurse-led, guideline-based collaborative care intervention compared with usual care for managing comorbid depression and chronic physical disease.
Interventional clinical trial (ClinicalTrials.gov number, NCT00468676) comparing a collaborative care model against standard usual care.
Intervention delivered by nurses providing guideline-based, patient-centered management targeting both depression and chronic illnesses.
Nurse-led collaborative care resulted in significantly greater control of chronic medical diseases compared with usual care.
The intervention produced significant improvements in depression outcomes relative to usual care.

Study Design

Type

RCT (n=214)

Blinding

Single-blind

Randomization

Permuted block randomization

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

Main Result

Effect estimate: null (95% CI null)

p-value: p=<0.001

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.

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.
The recruitment target of 290 patients was not reached

Implication

Supports implementation of nurse-led collaborative care for comorbid depression and diabetes or CHD; confirms integrated management benefits in multimorbidity.

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.).

Discussion

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Cite This Study

Katon et al. (2010) conducted an RCT in Depression and chronic illnesses (diabetes and coronary heart disease) (n=214). Collaborative care management vs. Usual care was evaluated on Improvement in glycated hemoglobin, LDL cholesterol, systolic blood pressure, and SCL-20 depression scores (null, 95% CI null, p=<0.001). 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.

synapsesocial.com/papers/697e5bfd0405ebd856e0940f https://doi.org/10.1056/nejmoa1003955

View Full Paper

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Bookmark

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Collaborative Care for Patients with Depression and Chronic Illnesses

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Collaborative Care for Patients with Depression and Chronic Illnesses

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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