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      Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model.

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          Abstract

          Patients with comorbid depression and physical health problems have poorer outcomes compared with those with single long term conditions (LTCs), or multiple LTCs without depression. Primary care has traditionally struggled to provide integrated care for this group. Collaborative care can reduce depression in people with LTCs but evidence is largely based on trials conducted in the United States that adopted separate treat to target protocols for physical and mental health. Little is known about whether collaborative care that integrates depression care within the management of LTCs is implementable in UK primary care, and acceptable to patients and health care professionals.

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          Most cited references22

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          The “core category” of grounded theory: Making constant comparisons

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            Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial.

            Joan Russo (2012)
            Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life. To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAMcare) compared with usual primary care (UC) in outpatients with depression and poorly controlled diabetes or CHD. Randomized controlled trial of a systematic care management program aimed at improving depression scores and hemoglobin A(1c) (HbA(1c)), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels. Fourteen primary care clinics of an integrated health care system. Population-based screening identified 214 adults with depressive disorder and poorly controlled diabetes or CHD. Physician-supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk factors. Blinded assessments evaluated depressive symptoms, SBP, and HbA(1c) at baseline and at 6, 12, 18, and 24 months. Fasting LDL-C concentration was assessed at baseline and at 12 and 24 months. Health plan accounting records were used to assess medical service costs. Quality-adjusted life-years (QALYs) were assessed using a previously developed regression model based on intervention vs UC differences in HbA(1c), LDL-C, and SBP levels over 24 months. Over 24 months, compared with UC controls, intervention patients had a mean of 114 (95% CI, 79 to 149) additional depression-free days and an estimated 0.335 (95% CI, -0.18 to 0.85) additional QALYs. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, -$3241 to $2053) relative to UC patients. For adults with depression and poorly controlled diabetes, CHD, or both, a systematic intervention program aimed at improving depression scores and HbA(1c), SBP, and LDL-C levels seemed to be a high-value program that for no or modest additional cost markedly improved QALYs. clinicaltrials.gov Identifier: NCT00468676
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              Improving outcomes in chronic illness.

              Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of a protocol, reorganization of practice systems and provider roles, improved patient education, increased access to expertise, and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care.
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                Author and article information

                Journal
                BMC Fam Pract
                BMC family practice
                Springer Science and Business Media LLC
                1471-2296
                1471-2296
                Mar 05 2015
                : 16
                Affiliations
                [1 ] NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK. sarah.knowles@manchester.ac.uk.
                [2 ] Primary Care and Health Sciences, University of Keele, and NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, Keele, ST5 5BG, UK. c.a.chew-graham@keele.ac.uk.
                [3 ] NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK. isabel.adeyemi@postgrad.manchester.ac.uk.
                [4 ] NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK. nia.coupe@postgrad.manchester.ac.uk.
                [5 ] NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK. peter.a.coventry@manchester.ac.uk.
                Article
                10.1186/s12875-015-0246-5
                10.1186/s12875-015-0246-5
                4355419
                25886864
                6bb1d145-7325-4408-9fec-0b068085c612
                History

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