Multi-centre Randomised Controlled Trial of Collaborative Care for Depression

在英国，抑郁症给许多人带来痛苦。在世界范围内，除心脏病外，受抑郁症影响的人比其他任何疾病都多。抑郁的人很难工作，也很难从事有意义的活动。抑郁症影响个人、他们的家庭、朋友和社区。改善初级保健对抑郁症的治疗可以对患者、他们的家庭和社会产生重大的积极影响。虽然初级保健的全科医生可以提供有效的治疗，但许多患者在接受治疗时需要额外的支持。缺乏这种支持往往会导致治疗失败。一种令人兴奋的组织治疗的新方式？？协作护理?？ 在美国被证明是有效的。这种治疗包括分配一名受过专门训练的工人。一个吗?案例管理器?？ 对抑郁症患者。病例管理员与患者、全科医生和心理健康专家合作，就患者的个人治疗计划达成一致。然后，病例管理人员与患者保持密切联系，以使该计划发挥作用。该计划包括与患者进行定期电话联系，为正在服药的患者提供支持，并就改善抑郁症的心理方法提供建议。病例管理人员定期听取精神科医生和心理学家的建议，并确保患者的心理健康。全科医生完全参与了治疗计划。最近，英国的三个研究小组已经证明，这些工作方法有可能适用于英国。这些小组现在已经一起计划在英国进行一项大型临床试验，以彻底测试这种新方法。该研究将通过将同意的患者分配到合作护理或患者通常从其全科医生那里获得的护理来测试合作护理。我们会仔细测量病人？研究前和四个月后的抑郁症状，以测试接受合作护理的患者是否比接受全科医生常规护理的患者更有改善。我们也会评估患者？12个月后再次出现症状。此外，我们将统计患者使用其他医疗服务的程度，并进行经济分析，以确定合作护理是否具有成本效益。如果，正如我们猜想的那样，我们能够证明接受合作治疗的人比接受常规治疗的人改善得更多，并且这是具有成本效益的，我们将确保合作治疗成为初级保健中支持抑郁症患者治疗的推荐方式。

Depression causes misery to many people in the UK. Worldwide, more people are affected by depression than any other condition apart from heart disease. Depressed people find it difficult to work and engage in meaningful activity. Depression affects individuals, their families, friends and their communities.Improving treatment for depression in primary care could have a major positive impact on patients, their families and society. Although effective treatments are available from GPs in primary care, many patients need additional support whilst they are being treated. Lack of this support often causes treatment to fail.An exciting new way of organising treatment ? ?collaborative care? ? has been shown to be effective in the United States. This treatment involves allocating a specially trained worker ? a ?case manager? ? to patients with depression. The case manager works with patients, GPs and mental health specialists to agree individual treatment plans for patients. The case manager then keeps in close touch with patients to make this plan work. This plan includes regular telephone contact with patients, support to those who are taking medication and advice about psychological ways to improve depression. The case manager accesses regular advice from psychiatrists and psychologists and ensures that the patient?s GP is fully involved in the treatment plan. Recently, three research groups in the UK have demonstrated that it may be possible to adapt these methods of working for the UK. These groups have now come together to plan a large clinical trial in the UK which will thoroughly test this new approach.The research study will test collaborative care by allocating consenting patients to either collaborative care or to the care a patient would usually receive from their GP. We will carefully measure patients? symptoms of depression before the study and after four months to test if patients receiving collaborative care are more improved that those receiving usual care from their GP. We will also assess patients? symptoms again after 12 months. In addition, we will count the extent to which patients have used other health services and do an economic analysis to see if collaborative care is cost effective.If, as we suspect, we are able to show that people receiving collaborative care improve more than people receiving usual care and that this is cost effective, we will ensure that collaborative care becomes the recommended way of supporting the treatment of people with depression in primary care.