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Depression care management for late-life depression in China primary care: protocol for a randomized controlled trial.

Chen S, Conwell Y, Xu B, Chiu H, Tu X, Ma Y - Trials (2011)

Bottom Line: Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision.Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months.Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychology, Zhejiang University, Hangzhou, Zhejiang, 310028, China. csl@zju.edu.cn

ABSTRACT

Background: As a major public health issue in China and worldwide, late-life depression is associated with physical limitations, greater functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China indicates should be managed in primary care settings. Collaborative care, linking primary and mental health specialty care, has been shown to be effective for the treatment of late-life depression in primary care settings in Western countries. The primary aim of this project is to implement a depression care management (DCM) intervention, and examine its effectiveness on the depressive symptoms of older patients in Chinese primary care settings.

Methods/design: The trial is a multi-site, primary clinic based randomized controlled trial design in Hangzhou, China. Sixteen primary care clinics will be enrolled in and randomly assigned to deliver either DCM or care as usual (CAU) (8 clinics each) to 320 patients (aged ≥ 60 years) with major depression (20/clinic; n = 160 in each treatment condition). In the DCM arm, primary care physicians (PCPs) will prescribe 16 weeks of antidepressant medication according to the treatment guideline protocol. Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision. Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months. Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes.

Discussion: This will be the first trial of the effectiveness of a collaborative care intervention aiming to the management of late-life depression in China primary care. If effective, its finding will have relevance to policy makers who wish to scale up DCM treatments for late-life depression in national wide primary care across China.

Study registration: The DCM project is registered through the National Institutes of Health sponsored by clinical trials registry and has been assigned the identifier: NCT01287494.

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Related in: MedlinePlus

Participants Recruitment Flowchart. (Key: PC-primary care, CRC- clinic research coordinator, DCM- depression care management, CAU- care as usual)
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Figure 1: Participants Recruitment Flowchart. (Key: PC-primary care, CRC- clinic research coordinator, DCM- depression care management, CAU- care as usual)

Mentions: After completion of the baseline diagnostic interview, eligible participants (i.e., those with major depression) who consent to participation will be assigned CAU or DCM based on which PCC they receive care from (see Figure 1). If patients present with acute suicide risk, psychosis, or severe cognitive impairment during the baseline assessment (i.e., exclusion criteria for the study), their PCP and family will be notified, and they will be given a referral for mental health specialists.


Depression care management for late-life depression in China primary care: protocol for a randomized controlled trial.

Chen S, Conwell Y, Xu B, Chiu H, Tu X, Ma Y - Trials (2011)

Participants Recruitment Flowchart. (Key: PC-primary care, CRC- clinic research coordinator, DCM- depression care management, CAU- care as usual)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3105939&req=5

Figure 1: Participants Recruitment Flowchart. (Key: PC-primary care, CRC- clinic research coordinator, DCM- depression care management, CAU- care as usual)
Mentions: After completion of the baseline diagnostic interview, eligible participants (i.e., those with major depression) who consent to participation will be assigned CAU or DCM based on which PCC they receive care from (see Figure 1). If patients present with acute suicide risk, psychosis, or severe cognitive impairment during the baseline assessment (i.e., exclusion criteria for the study), their PCP and family will be notified, and they will be given a referral for mental health specialists.

Bottom Line: Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision.Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months.Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychology, Zhejiang University, Hangzhou, Zhejiang, 310028, China. csl@zju.edu.cn

ABSTRACT

Background: As a major public health issue in China and worldwide, late-life depression is associated with physical limitations, greater functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China indicates should be managed in primary care settings. Collaborative care, linking primary and mental health specialty care, has been shown to be effective for the treatment of late-life depression in primary care settings in Western countries. The primary aim of this project is to implement a depression care management (DCM) intervention, and examine its effectiveness on the depressive symptoms of older patients in Chinese primary care settings.

Methods/design: The trial is a multi-site, primary clinic based randomized controlled trial design in Hangzhou, China. Sixteen primary care clinics will be enrolled in and randomly assigned to deliver either DCM or care as usual (CAU) (8 clinics each) to 320 patients (aged ≥ 60 years) with major depression (20/clinic; n = 160 in each treatment condition). In the DCM arm, primary care physicians (PCPs) will prescribe 16 weeks of antidepressant medication according to the treatment guideline protocol. Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision. Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months. Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes.

Discussion: This will be the first trial of the effectiveness of a collaborative care intervention aiming to the management of late-life depression in China primary care. If effective, its finding will have relevance to policy makers who wish to scale up DCM treatments for late-life depression in national wide primary care across China.

Study registration: The DCM project is registered through the National Institutes of Health sponsored by clinical trials registry and has been assigned the identifier: NCT01287494.

Show MeSH
Related in: MedlinePlus