Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial
Abstract Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-022-01803-x |
| _version_ | 1811320638994907136 |
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| author | Sandra af Winklerfelt Hammarberg Cecilia Björkelund Shabnam Nejati Maria Magnil Dominique Hange Irene Svenningsson Eva-Lisa Petersson Malin André Camilla Udo Nashmil Ariai Lars Wallin Carl Wikberg Jeanette Westman |
| author_facet | Sandra af Winklerfelt Hammarberg Cecilia Björkelund Shabnam Nejati Maria Magnil Dominique Hange Irene Svenningsson Eva-Lisa Petersson Malin André Camilla Udo Nashmil Ariai Lars Wallin Carl Wikberg Jeanette Westman |
| author_sort | Sandra af Winklerfelt Hammarberg |
| collection | DOAJ |
| description | Abstract Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls. Trial registration ClinicalTrials.gov identifier: NCT02378272. Submitted 2/2/2015. Posted 4/3/2015. |
| first_indexed | 2024-04-13T13:02:59Z |
| format | Article |
| id | doaj.art-87b4bcf3923343e2a0ad26fe05abce6b |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-04-13T13:02:59Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-87b4bcf3923343e2a0ad26fe05abce6b2022-12-22T02:45:52ZengBMCBMC Primary Care2731-45532022-08-0123111010.1186/s12875-022-01803-xClinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trialSandra af Winklerfelt Hammarberg0Cecilia Björkelund1Shabnam Nejati2Maria Magnil3Dominique Hange4Irene Svenningsson5Eva-Lisa Petersson6Malin André7Camilla Udo8Nashmil Ariai9Lars Wallin10Carl Wikberg11Jeanette Westman12Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDepartment of Public Health and Caring Sciences – Family Medicine and Preventive Medicine, Uppsala UniversitySchool of health and Welfare, Dalarna UniversityDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgSchool of health and Welfare, Dalarna UniversityDepartment of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of GothenburgDivision of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetAbstract Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls. Trial registration ClinicalTrials.gov identifier: NCT02378272. Submitted 2/2/2015. Posted 4/3/2015.https://doi.org/10.1186/s12875-022-01803-xCare managerCollaborative careDepressionPrimary health careQuality of lifeSymptom severity |
| spellingShingle | Sandra af Winklerfelt Hammarberg Cecilia Björkelund Shabnam Nejati Maria Magnil Dominique Hange Irene Svenningsson Eva-Lisa Petersson Malin André Camilla Udo Nashmil Ariai Lars Wallin Carl Wikberg Jeanette Westman Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial BMC Primary Care Care manager Collaborative care Depression Primary health care Quality of life Symptom severity |
| title | Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial |
| title_full | Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial |
| title_fullStr | Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial |
| title_full_unstemmed | Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial |
| title_short | Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial |
| title_sort | clinical effectiveness of care managers in collaborative primary health care for patients with depression 12 and 24 month follow up of a pragmatic cluster randomized controlled trial |
| topic | Care manager Collaborative care Depression Primary health care Quality of life Symptom severity |
| url | https://doi.org/10.1186/s12875-022-01803-x |
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