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要多。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、他们的家人、朋友和他们的社区。改善初级保健中的抑郁症治疗可能会对患者、他们的家庭和社会产生重大的积极影响。尽管全科医生在初级保健中提供了有效的治疗，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。组织治疗的一种令人兴奋的新方式？？协作护理？？在美国已经被证明是有效的。这种治疗包括分配一名受过专门培训的工人？A？案例经理？？给抑郁症患者。病例经理与患者、全科医生和精神健康专家合作，就患者的个体化治疗计划达成一致。然后，病例经理与患者保持密切联系，以使这一计划奏效。该计划包括定期与患者进行电话联系，支持那些正在服药的人，并就改善抑郁症的心理方法提供建议。病例经理定期咨询精神科医生和心理学家的意见，确保患者S全科医生全面参与治疗计划。最近，英国的三个研究小组证明，或许有可能调整这些为英国工作的方法。这些组织现在已经联合起来，计划在英国进行一项大型临床试验，彻底测试这一新方法。研究将通过将同意的患者分配到协作护理或患者通常从他们的全科医生那里得到的护理来测试协作护理。我们会仔细测量病人吗？在研究前和四个月后测试接受协作护理的患者是否比接受普通全科医生护理的患者更好地改善抑郁症状。我们还会评估病人吗？12个月后再次出现症状。此外，我们将计算患者使用其他医疗服务的程度，并进行经济分析，看看协同护理是否具有成本效益。如果像我们怀疑的那样，我们能够证明接受协同护理的人比接受常规护理的人改善更多，并且这是具有成本效益的，我们将确保协同护理成为支持初级保健中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.