Depression in older adults: collaborative care model seems effective

Publication Summary

ED FROM Chew-Graham CA, Lovell K, Roberts C, et al. A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people. Br J Gen Pract 2007;57:364–70. Correspondence to: Heather Burroughs, Rusholme Academic Unit, Division of Primary Care, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK; [email protected] Source of funding: Department of Health. c Additional notes are published online only at http://ebmh.bmj.com/content/vol11/ issue2 C O M M EN TA R Y T he quality of primary care for depression is generally poor, with inconsistent follow-up, inadequate provision of psychological interventions and suboptimal use of medication. Collaborative care has emerged as the most effective way of organising and delivering primary care for depression and addresses these problems directly. Depression outcomes are consistently improved with collaborative care, both in the short and longer term. The core feature of collaborative care is the presence of a case manager who facilitates evidence-supported interventions for depression (medication management and/or brief psychotherapy). Case managers ensure follow-up and monitor progress, in close liaison with the primary care physician and with the support of a mental health specialist (psychiatrist or psychologist). Collaborative care seems to be effective across the age spectrum, but the vast majority of studies have been conducted in the USA. The study by Chew Graham and colleagues adapts this model of care to an elderly UK population for the first time, where Community Psychiatric Nurses (CPNs) adopt the ‘‘case manager’’ role. Collaborative care was effective in improving depression symptoms compared to ‘‘usual care’’. The results are in line with the 37+ studies of collaborative care to date, and a much larger US study in an elderly population. What is important about this study is the demonstration of the effectiveness of collaborative care beyond USmanaged care settings. Participants found the use of telephone monitoring and follow-up acceptable, and this challenges traditional models of low caseload/high intensity nursing care delivered in traditional community mental health services. This has important implications for the delivery of services and implementation of this model of care. This is a small-scale pilot study, and further research is needed. In particular, the ‘‘active ingredients’’ of this intervention were unclear, and deserve further research. Professor Simon Gilbody, DPhil, MRCPsych Professor of Psychological Medicine and Health Services Research, University of York, York, UK Competing interests: None. 1. Gilbody S, Bower P, Fletcher J, et al. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006;166:2314–21. 2. Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2003; 288:2836–45. 3. Richards, DA, Lankshear A, Fletcher J, et al. Developing a UK protocol for collaborative care: a qualitative study. Gen Hosp Psychiatry 2006;28: 296–305. Therapeutics 44 EBMH May 2008 Vol 11 No 2