Collaborative care for depression and anxiety problems

Archer, Janine; Bower, Peter; Gilbody, Simon; Lovell, Karina; Richards, David; Gask, Linda; Dickens, Chris; Coventry, Peter

doi:10.1002/14651858.cd006525.pub2

Cited by 745 publications

(660 citation statements)

References 418 publications

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“…No se encontraron en la literatura estudios que hayan medido la efectividad de programas colaborativos en países en vías de desarrollo. Una reciente revisión adjudica los beneficios a largo plazo que los modelos colaborativos logran en el manejo de la depresión al hecho de haber incluido principios del tratamiento de las enfermedades crónicas 32 . Hoy día sólo falta avanzar en la implementación cuidadosa de este tipo de intervenciones.…”

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“…Hoy día sólo falta avanzar en la implementación cuidadosa de este tipo de intervenciones. Los programas colaborativos son complejos pues incluyen varios componentes por lo que es necesario avanzar en la investigación de los componentes más activos de los programas para focalizar su uso en la población que sufre la enfermedad 32 . En el caso de nuestra intervención los componentes eran el tratamiento del equipo de atención primaria que podía incluir farmacoterapia y psicoterapia, la supervisión en línea por parte de un equipo especializado y la monitorización telefónica del tratamiento por parte de una profesional de la salud y el diseño del estudio no nos permite concluir la contribución de cada componente en los resultados obtenidos.…”

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Programa colaborativo a distancia para el tratamiento de la enfermedad depresiva

et al. 2014

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) in the BDI-I and 38% of them had a high suicide risk. There were no statistically significant baseline differences between active and control group. In the intervention group, the BDI-I score changed from 30.0 (95% CI 27.0 to 32.8) to 15.3 (95% CI 11.8 to 18.8). In the control group the score changed from . The decrease was significantly higher in the intervention groups. Conclusions: A program of this kind may be useful to assist primary care teams in remote areas of the country to improve treatment outcomes for depression. (Rev Med Chile 2014; 142: 1142-1149

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Programa colaborativo a distancia para el tratamiento de la enfermedad depresiva

et al. 2014

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“…36 Given the high prevalence of coexisting behavioral health comorbidities among patients receiving opioids for chronic non-cancer pain, 37,38 approaches that promote close collaboration with mental health and addiction specialists will also be important for this population. 39,40 Conversely, the complex only group comprises patients with increased medical complexity as evidenced by older age, higher number of prescribed medications, and multiple behavioral health and social issues. However, these complex issues do not drive frequent acute care utilization or primary care team effort in the ways the data might predict.…”

Section: Discussionmentioning

confidence: 99%

Defining Team Effort Involved in Patient Care from the Primary Care Physician’s Perspective

et al. 2016

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BACKGROUND: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians. OBJECTIVE: To identify and characterize high-effort patients from the physician's perspective. DESIGN: Cohort study. PARTICIPANTS: Ninety-nine primary care physicians in an academic primary care network. MAIN MEASURES: From a list of 100 randomly selected patients in their panels, PCPs identified patients who required a high level of team-based effort and patients they considered complex. For high-effort patients, PCPs indicated which factors influenced their decision: medical/ care coordination, behavioral health, and/or socioeconomic factors. We examined differences in patient characteristics based on PCP-defined effort and complexity. KEY RESULTS: Among 9594 eligible patients, PCPs classified 2277 (23.7 %) as high-effort and 2676 (27.9 %) as complex. Behavioral health issues were the major driver of effort in younger patients, while medical/care coordination issues predominated in older patients. Compared to low-effort patients, high-effort patients were significantly (P < 0.01 for all) more likely to have higher rates of medical (e.g. 23.2 % vs. 6.3 % for diabetes) and behavioral health problems (e.g. 9.8 % vs. 2.9 % for substance use disorder), more frequent primary care visits (10.9 vs. 6.0 visits), and higher acute care utilization rates (25.8 % vs. 7.7 % for emergency department [ED] visits and 15.0 % vs. 3.9 % for hospitalization). Almost one in five (18 %) patients who were considered high-effort were not deemed complex by the same PCPs. CONCLUSIONS: Patients defined as high-effort by their primary care physicians, not all of whom were medically complex, appear to have a high burden of psychosocial issues that may not be accounted for in current chronic disease-focused risk adjustment approaches.KEY WORDS: primary care redesign; psychosocial; health services research; resource allocation; risk adjustment.

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“…The effect size for anxiety was 0.23 at 4-month follow-up, a significant between-group difference that was sustained at 12-month follow-up and comparable with the average effect sizes of 0.30 to 0.33 reported in other studies examining collaborative care for anxiety. 4,5 The reduction in anxiety is especially important because anxiety has a similar prevalence as depression in primary care practice and is present in a third to half of patients with depression. 1 Another important aspect of the CASPER intervention was that it was brief and relatively inexpensive.…”

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When and How to Treat Subthreshold Depression

Kroenke

2017

JAMA

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Depressive disorders are present in about 10% of primary care patients and account for more years lived with disability than any single disease. 1,2 Nearly three-quarters of all outpatient visits for depression are to primary care clinicians rather than to mental health specialists. 3 Collaborative care is a therapeutic intervention in which behavioral health is integrated into primary care, most commonly using a nurse care manager to monitor depressive symptoms in depressed patients and adjust treatment under the supervision of a psychiatrist. Many of the nurse contacts are conducted by telephone, thereby increasing the efficiency of collaborative care. Although collaborative care has been demonstrated to improve depression in more than 80 randomized clinical trials, 4,5 most trials have targeted major depression.Major depression requires the presence of at least 5 of 9 criterion symptoms of depression for 2 weeks or longer, with at least 1 of the symptoms being depressed mood or anhedonia. 6 In comparison, subthreshold depression (also called minor or subsyndromal depression) is the presence of 2 to 4 criterion symptoms of depression for 2 weeks or longer with at least 1 of the core symptoms (depressed mood or anhedonia). 6,7 Alternative definitions of subthreshold depression use a severity cut point on a depression scale or vary in duration and core symptom requirements but typically require the absence of major depression. Only a small number of therapeutic trials have targeted subthreshold depression, and results have been mixed. 6,8 Identifying effective therapies for subthreshold depression is important because many patients with subthreshold depression have persistent depressive symptoms at 12-month follow-up, a third to half report moderate functional impairment, and at least 10% to 20% progress to major depression. 6,7,9,10 In this issue of JAMA, the CASPER trial by Gilbody et al 11 provides the first evidence that collaborative care may benefit patients with subthreshold depression. In this pragmatic clinical trial conducted in the United Kingdom, the authors randomized 705 adults aged 65 years or older with subthreshold depression to either a collaborative care intervention or usual primary care. The collaborative care treatment consisted of 8 weekly 30-minute sessions of behavioral activation administered by a care manager with a background in mental health nursing or psychology who was supervised by a mental health professional. Behavioral activation is a psychological intervention that encourages increased social interactions and engagement in pleasur-Editorial Opinion

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Collaborative care for depression and anxiety problems

Cited by 745 publications

References 418 publications

Programa colaborativo a distancia para el tratamiento de la enfermedad depresiva

Programa colaborativo a distancia para el tratamiento de la enfermedad depresiva

Defining Team Effort Involved in Patient Care from the Primary Care Physician’s Perspective

When and How to Treat Subthreshold Depression

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