Research theme: Healthcare practitioners
What did we do?
We developed and tested the cost-effectiveness of a collaborative care programme to improve access to, and the quality of, care for depression in two exemplar long-term conditions: diabetes and/or coronary heart disease.
Why was it important?
When combined with a long-term condition, depression leads to the greatest reductions in quality of life. Depression and anxiety are known to drive unscheduled care in the health service, and the health economic impact of mental and physical multimorbidity is significant. Work by the King’s Fund has shown that depression increases the cost of care for patients with long-term conditions by at least 45%, or from £3910 to £5670 a year. Managing mental and physical multimorbidity is difficult and poses challenges for all health services.
How did we do it?
In our COllaborative INterventions for CIrculation and DEpression (COINCIDE) trial we evaluated the effectiveness and cost-effectiveness of collaborative care in treating symptoms of depression in patients who have coronary heart disease and/or diabetes. We trained Psychological Well Being Practitioners to be case managers and to adopt a collaborative approach to treatment.
The key output from this study is “Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease“, a paper published in the BMJ in 2015.
Other outputs are as follows:
Coventry PA., Donnelly A. 2014. Is collaborative care more effective in patients with depression and co-morbid physical disease? Meta-analysis and meta-regression [lay summary].
Coventry PA. et al. 2011. Talking about depression: a qualitative study of barriers to managing depression in people with long-term conditions in primary care. BMC Family Practice 12: 10.
Dickens C. et al. 2013. Characteristics of psychological interventions that improve depression in people with coronary heart disease: A systematic review and meta-regression. Pyschosomatic Medicine, Vol 75 No. 2.
Garrett CR. et al. 2012. Accessing primary health care: A meta-ethnography of the experiences of British South Asian patients with diabetes, coronary heart disease or a mental health problem. Chronic Illness, 8: 135.
Knowles SE et al. 2013. Better together? A naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems. Implementation Science, 8: 110.