Collaborative care for patients with depression and chronic illnesses

January 01, 0001

Collaborative care for patients with depression and chronic illnesses

Patients with depression and poorly controlled diabetes, coronary heart disease, or both have an increased risk of adverse outcomes and high health care costs. These US authors conducted a single-blind, randomized, controlled trial in 14 primary care clinics in an integrated health care system in Washington State, involving 214 participants with poorly controlled diabetes, coronary heart disease, or both and coexisting depression. Patients were randomly assigned to the usual-care group or to the intervention group, in which a medically supervised nurse, working with each patient's primary care physician, provided guideline-based, collaborative care management, with the goal of controlling risk factors associated with multiple diseases.

They found: "As compared with controls, patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels (difference, 0.58%), LDL cholesterol levels (difference, 6.9 mg per deciliter {0.2 mmol per liter}), systolic blood pressure (difference, 5.1 mm Hg), and Symptom Checklist-20 depression scores (difference, 0.40 points). Patients in the intervention group also were more likely to have one or more adjustments of insulin, antihypertensive medications, and antidepressant medications, and they had better quality of life and greater satisfaction with care for diabetes, coronary heart disease, or both and with care for depression."

The authors concluded: "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."

It would be good to know additional outcomes including hospitalizations, emergency department visits, and costs.

For the full abstract, click here.

N Engl J Med 363:2611-262, 30 December 2010
© 2010 to the Massachusetts Medical Society
Collaborative Care for Patients with Depression and Chronic Illnesses. Wayne J. Katon, Elizabeth H.B. Lin, Michael Von Korff, et al. Correspondence to Dr. Katon: [email protected].

Category: HSR. Health Services Research. Keywords: diabetes, coronary heart disease, depression, care coordination, collaborative care management, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 14 January 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.