Hedrick 2003.

Methods	Randomised trial of consultation liaison compared to collaborative care.
Participants	Consumers (n = 354): consumers who had been identified as having depression or dysthymia in two other studies, through a check‐in survey, or by referral from their primary care provider. The mean age was 57.2 years, 95.5% were male, 79.7% were white, 53.6% had had previous depression, 59.7% had major depression and 60.7% had both depression and dysthymia. Excluded: consumers with recent or scheduled mental health clinic appointments, requiring treatment for substance use or PTSD, suicidality, psychosis or other condition requiring immediate treatment. Primary care providers (n = 67): doctors (19 physicians, 38 residents, 10 fellows) and 22 nurse practitioners working for the General Internal Medicine Clinic. All were provided with three hours education on depression assessment, treatment and resources. Mental health specialists (n > 10): CL team included a full‐time psychiatry resident, psychiatrist consultant, clinical psychologists and interns, four social workers and interns. Setting: Veteran’s Affairs clinics, 1998‐9 USA.
Interventions	1. Consultation Liaison (n = 186) Mental health specialist/consumer: mental health specialists provided treatment directly to consumers in the primary care setting if appropriate or they were referred to speciality mental health clinics. Mental health specialist/primary care provider: mental health specialist clinicians informed primary care provider of consumer diagnosis and facilitated referral to psychiatry residents, psychologist and/or social workers within the clinic. Primary care providers consulted with, or referred to Mental health specialists ‘as deemed necessary’. Consumer/Primary care provider: primary care provider responsible for initiating treatment and co‐ordinating consumers' overall care. Primary care providers also able to refer to psychologists and social workers working at clinic. 2. Collaborative care (n = 168) Collaborative care team (n > 5) included a clinical psychologist, psychiatrist, social workers and "psychology technician". Mental health specialist/consumer: treatment options included medication, six sessions of group CBT, and referral to speciality care. The social worker or students contacted consumers on a ‘regular schedule’ to encourage adherence, address treatment barriers and assess response. All consumers received a video and workbook. Mental health specialist/primary care provider: the collaborative care mental health team informed the primary care provider of the consumer's diagnosis, provided a treatment plan, consulted on any disagreements over treatment, monitored primary care provider adherence to the plan, reviewed treatment results and communicated with the primary care provider via electronic progress notes. Primary care providers were also able to refer to psychologists and social workers working at the clinic.
Outcomes	1. Consumer Improvement: 50% reduction in SCL‐20 score. Symptoms: Hopkins SCL‐20 depression scale, Veterans Short Form (SF)‐36 mental component summary at three and nine months. Satisfaction: Consumer satisfaction scale (five items) at three and nine months. Diability: Sheehan Disability Scale (three items) at three and nine months. 2. Provider Prescribing: consumers prescribed antidepressants over nine months, consumers prescribed minimum therapeutic dose of antidepressants over nine months. Cost: Total cost per consumer over nine months.
Notes	Note: the SCL‐20 average item score was reported. The number of consumers that no longer had SCL‐20 cutoff scores for major depression of more than 1.75 were also reported but because this was a subset of all consumers 50% change from baseline scores were used for improvement.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Consumers were randomised by the General Internal Medicine Clinic, sequence generation not described.
Allocation concealment (selection bias)	Unclear risk	Not reported.
Blinding (performance bias and detection bias) All outcomes	High risk	Consumer outcome measures were administered by graduate students who were not informed of a participant's group membership; however, outcomes were self‐reported and participants in the CC group were probably aware they were receiving specialist treatment.
Incomplete outcome data (attrition bias) All outcomes	High risk	Data were reported for those available at follow‐up, loss to follow‐up at three months 7%, nine months 8%.
Selective reporting (reporting bias)	Unclear risk	The decision to report the number of consumers prescribed antidepressants (but not the number receiving therapeutic doses) may have been post hoc.
Other bias	Unclear risk	The collaborative care group were more likely to have previous depression (59.5% vs 48.4%) and to have major depression (65% vs 55%).