Abstract
BackgroundMeta-analyses suggest that collaborative care (CC) improves symptoms of depression and anxiety. In CC, a care manager collaborates with a general practitioner (GP) to provide evidence-based care. Most CC research is from the US, focusing on depression. As research results may not transfer to other settings, we developed and tested a Danish CC-model (the Collabri-model) for depression, panic disorder, generalized anxiety disorder, and social anxiety disorder in general practice.MethodsFour cluster-randomized superiority trials evaluated the effects of CC. The overall aim was to explore if CC significantly improved depression and anxiety symptoms compared to treatment-as-usual at 6-months’ follow-up. The Collabri-model was founded on a multi-professional collaboration between a team of mental-health specialists (psychiatrists and care managers) and GPs. In collaboration with GPs, care managers provided treatment according to a structured plan, including regular reassessments and follow-up. Treatment modalities (cognitive behavioral therapy, psychoeducation, and medication) were offered based on stepped care algorithms. Face-to-face meetings between GPs and care managers took place regularly, and a psychiatrist provided supervision. The control group received treatment-as-usual. Primary outcomes were symptoms of depression (BDI-II) and anxiety (BAI) at 6-months’ follow-up. The incremental cost-effectiveness ratio (ICER) was estimated based on 6-months’ follow-up.ResultsDespite various attempts to improve inclusion rates, the necessary number of participants was not recruited. Seven hundred thirty-one participants were included: 325 in the depression trial and 406 in the anxiety trials. The Collabri-model was implemented, demonstrating good fidelity to core model elements. In favor of CC, we found a statistically significant difference between depression scores at 6-months’ follow-up in the depression trial. The difference was not significant at 15-months’ follow-up. The anxiety trials were pooled for data analysis due to inadequate sample sizes. At 6- and 15-months’ follow-up, there was a difference in anxiety symptoms favoring CC. These differences were not statistically significant. The ICER was 58,280 Euro per QALY.ConclusionsAt 6 months, a significant difference between groups was found in the depression trial, but not in the pooled anxiety trial. However, these results should be cautiously interpreted as there is a risk of selection bias and lacking statistical power.Trial registrationClinicalTrials.gov, ID: NCT02678624 and NCT02678845. Retrospectively registered on 7 February 2016.
Highlights
Meta-analyses suggest that collaborative care (CC) improves symptoms of depression and anxiety
In favor of CC, we found a statistically significant difference between depression scores at 6-months’ follow-up in the depression trial
At 6 months, a significant difference between groups was found in the depression trial, but not in the pooled anxiety trial
Summary
Meta-analyses suggest that collaborative care (CC) improves symptoms of depression and anxiety. Research suggests that collaborative care can be a useful organizational model for treating depression and anxiety disorders in this setting [3,4,5]. A meta-analysis from 2012 found that collaborative care was associated with larger short-, medium- and long-term improvements in symptoms compared with usual care for people with depression and anxiety [3]. The authors emphasized a need for more research in collaborative care for anxiety disorders, and that the findings should be interpreted more cautiously in settings different from that of the United States [3]. A subsequent systematic review and meta-analysis, including depression trials in European countries, showed that collaborative care seems to be more effective than usual care in improving depression scores outside the United States [4]. In 2018, a Swedish cluster-randomized collaborative care trial for depression showed a reduction in depression scores at 3- and 6months’ follow-up, which was significantly greater in the intervention group vs. the control group when measured by MADRS-S but not by BDI-II [6]
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