Chew‐Graham 2007.
| Methods | Study design: Randomised controlled trial | |
| Participants | Setting: Primary Care Diagnosis: Clinically identified as depressed. Score of 5 or more on the Geriatric Depression Scale (GDS) and 24 or more on the Mini‐Mental State Exam (MMSE) Inclusion criteria: Over the age of 60 Exclusion criteria: Not stated Age: Mean 75.5 years Gender: 72% female Ethnicity: Not stated Country: United Kingdom Sample size (randomised): Total participants 105, intervention 53, control 52 |
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| Interventions | Intervention: Collaborative care Contains the four elements of collaborative care: 1) a multi‐professional approach to patient care: GP (PCP), community psychiatric nurse (CM), old age psychiatrist (MH specialist) 2) a structured management plan: The complex intervention included education about depression, advice about antidepressant medication, a manualised facilitated self‐help intervention (SHADE), and sign‐posting to other services, particularly voluntary agencies. 3) scheduled patient follow‐ups: The intervention lasted for 12 weeks and consisted of six face‐to‐face sessions in each patient’s home and five sessions delivered via the telephone 4) enhanced inter‐professional communication: CM liaised closely with PCPs and had regular access to advice from MH specialist according to a defined protocol. The protocol did not define how often the CM liaised with the PCP (by post, email, telephone, or face‐to‐face) but the CM sent a written report to the PCP at assessment, 4, 8 and 12 weeks. In between, the CM liaised with the PCP in‐person if changes in medication were required or if there were concerns about concordance or risk. CM reviewed patients’ progress with MH specialist every 4 weeks or sooner if CM had concerns. Control: Treatment as usual enhanced as all practices were supplied with hand delivered guidelines which outlined diagnostic criteria, suggestions of appropriate investigations, and the primary care management of depression in older people |
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| Outcomes | Depression (HSCL‐20): 4 months | |
| Notes | CM: case manager; GP: general practitioner; HSCL: Hopkins Sympton Checklist; MH: mental health; PCP: primary care provider | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer generated |
| Allocation concealment (selection bias) | Low risk | Allocation conducted by an individual not involved in patient recruitment |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Short‐term loss to follow‐up based on primary depression outcome (Proportion with 5+ symptoms on SCID) was: overall 17/105(16%), 8/53(15%) intervention and 9/52(17%) control. Reasons for loss to follow‐up provided, with similar reasons across groups. Used intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information available to assess |
| Other bias | Unclear risk | Insufficient information available to assess |
| Implementation Integrity | Unclear risk | Insufficient information available to assess |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel could not be blinded, outcome likely to be influenced by lack of blinding |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Assessor was not aware of treatment allocation |