Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial
Abstract Background Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. O...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | BMC Family Practice |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12875-018-0711-z |
| _version_ | 1811229091677863936 |
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| author | Cecilia Björkelund Irene Svenningsson Dominique Hange Camilla Udo Eva-Lisa Petersson Nashmil Ariai Shabnam Nejati Catrin Wessman Carl Wikberg Malin André Lars Wallin Jeanette Westman |
| author_facet | Cecilia Björkelund Irene Svenningsson Dominique Hange Camilla Udo Eva-Lisa Petersson Nashmil Ariai Shabnam Nejati Catrin Wessman Carl Wikberg Malin André Lars Wallin Jeanette Westman |
| author_sort | Cecilia Björkelund |
| collection | DOAJ |
| description | Abstract Background Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [− 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients. Trial registration Identifier: NCT02378272. February 2, 2015. Retrospectively registered. |
| first_indexed | 2024-04-12T10:08:39Z |
| format | Article |
| id | doaj.art-40e40dc5a81c4bcb8db2e5c6b15e2490 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-12T10:08:39Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-40e40dc5a81c4bcb8db2e5c6b15e24902022-12-22T03:37:22ZengBMCBMC Family Practice1471-22962018-02-0119111010.1186/s12875-018-0711-zClinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trialCecilia Björkelund0Irene Svenningsson1Dominique Hange2Camilla Udo3Eva-Lisa Petersson4Nashmil Ariai5Shabnam Nejati6Catrin Wessman7Carl Wikberg8Malin André9Lars Wallin10Jeanette Westman11Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgDepartment of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgDepartment of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgSchool of Education, Health and Social Studies, Dalarna UniversityDepartment of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgDepartment of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgDepartment of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgHealth Metrics Unit, Sahlgrenska Academy, University of GothenburgDepartment of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala UniversitySchool of Education, Health and Social Studies, Dalarna UniversityDivision of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstituteAbstract Background Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [− 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients. Trial registration Identifier: NCT02378272. February 2, 2015. Retrospectively registered.http://link.springer.com/article/10.1186/s12875-018-0711-zDepressionPrimary careCare managerCollaborative careSick-leaveQuality-of- life |
| spellingShingle | Cecilia Björkelund Irene Svenningsson Dominique Hange Camilla Udo Eva-Lisa Petersson Nashmil Ariai Shabnam Nejati Catrin Wessman Carl Wikberg Malin André Lars Wallin Jeanette Westman Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial BMC Family Practice Depression Primary care Care manager Collaborative care Sick-leave Quality-of- life |
| title | Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial |
| title_full | Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial |
| title_fullStr | Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial |
| title_full_unstemmed | Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial |
| title_short | Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial |
| title_sort | clinical effectiveness of care managers in collaborative care for patients with depression in swedish primary health care a pragmatic cluster randomized controlled trial |
| topic | Depression Primary care Care manager Collaborative care Sick-leave Quality-of- life |
| url | http://link.springer.com/article/10.1186/s12875-018-0711-z |
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