Journal Article Annotations
2017, 4th Quarter
Annotations by Walter Luchsinger, MD, and Lydia Chwastiak, MD, MPH, FAPM
Type of study: Multi-site randomized controlled trial
The finding: This very large multi-center (69 General Medical Practices) randomized controlled trial, compared a low intensity collaborative care model to usual primary care for the treatment of depression among elderly primary care patients. Patients randomized to collaborative care had statistically significantly less severe depression after 4 months (effect size =0.34). These treatment differences were not maintained at 12- or 18-month follow-up. Among patients who received six or more sessions of collaborative care, this intervention appeared to be very cost-effective (less so for those receiving fewer sessions).
Strength and weaknesses: The main strength of the study is the randomized controlled trial design. This was also a very pragmatic trial, and the size of the patient sample and the number of practices included increase the generalizability of the findings.
Limitations are included in the abstract. The potential contamination and the differential attrition rates are the most likely to have affected the study outcomes
Relevance: While substantial evidence supports the effectiveness of collaborative care for the treatment of depression in primary care, few studies have reported long-term follow-up (this study includes follow-up at 12- and 18-months, and did not find a sustained benefit from the intervention).
Type of study: Randomized controlled trial
The finding: This randomized controlled trial conducted in two community mental health centers (CMHC) compared a pilot testing of a CMHC-based collaborative care model, adapted from primary care-based TEAMcare model vs usual care to treat poorly controlled type II diabetes in adults receiving outpatient treatment for psychosis. Adults that were randomized to the CMHC-based collaborative care model had a statistically significant (p=.049) mean decrease in hemoglobin A1c of 1.1% after 3 months compared to no significant change in hemoglobin A1c in the usual care group. This pilot study demonstrated preliminary effectiveness of a CMHC-based collaborative care model in a CHMC to improve glycemic control in adults receiving outpatient treatment for psychosis and with poorly controlled type II diabetes.
Strength and weaknesses: The main strength of the study is the randomized controlled trial design.
Weaknesses: First, the study involved a small number of participants from two CMHCs in a single city, which may limit the generalizability of the findings. Second, almost 10% of patient who met clinical eligibility criteria were excluded because of their inability to speak English and some of these patients may have responded differently to the intervention. In addition, patient who were lost to follow-up may have been more likely to have poor outcomes. Finally, the short duration of the study precluded examination of sustainability of the positive changes observed at the end of the intervention or of any long-term outcomes.
Relevance: Few studies have evaluated the effectiveness of care models to improve the quality of medical care in people with psychotic disorders.