Schrader 2005.
Methods | Cluster‐randomised controlled trial of consultation liaison compared to standard care. | |
Participants |
Consumers (n = 669): consumers hospitalised for a range of cardiac conditions and identified as depressed (CES‐D score of 16 or more). They were aged 18 to 84 years, 62% were male, and 45% had moderate to severe depression. Exclusions: severe cognitive or physical impairment, participants in other trials, limited English. Primary care providers (n = 480): GPs. Mental health specialists (n not known): psychiatric registrars, psychiatrist and cardiac rehabilitation nurse. Setting: consumers were enrolled from four urban hospitals in Adelaide, Australia 2000‐2001 but consultation liaison care was delivered in conjunction with the consumer's GP. |
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Interventions | 1. Consultation Liaison (n = 331) Mental health specialist/consumer: consumers were referred to the psychiatric CL unit while in hospital for a consultation of 20‐30 minutes with the psychiatric registrar and cardiac rehabilitation nurse. Mental health specialist/primary care provider: GPs were invited to a 15 to 30 minute phone case conference with the attending psychiatric registrar and cardiac rehabilitation nurse. If this was not possible, the GP was offered a 5 to 10 minute phone call with a psychiatrist who had not seen the consumer for management suggestions. The consumer's depression scores and guide for the recognition and treatment of depression (medication and CBT) was sent to all participating GPs. The percentage of GPs participating in the case conference was 24%, receiving a call from the psychiatrist was 40%, and just received the consumer's scores and treatment guide was 36%. Primary care provider/consumer: interaction not reported. 2. Standard care (n = 338) Consumers in the standard care group received usual cardiac and non‐cardiac care in the hospital and community. |
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Outcomes | 1. Consumer Improved: no longer categorised as depressed according to CES‐D scores at 12 months. Health: SF‐36 physical health subscale at 12 months. 2. Provider No provider outcomes were reported. |
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Notes | ||
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk | 'Centrally randomised' by GP. |
Allocation concealment (selection bias) | Unclear risk | Not described. |
Blinding (performance bias and detection bias) All outcomes | High risk | Blinding was not described but consumers were probably aware they were in the active group. |
Incomplete outcome data (attrition bias) All outcomes | High risk | Loss to follow‐up was very high (33%). |
Selective reporting (reporting bias) | High risk | Did not report SF‐36 mental health scores. |
Other bias | Low risk | None identified. |