Long-term effects of a collaborative care intervention on process of care in family practices in Germany: a 24-month follow-up study of a cluster randomized controlled trial

• Published in: General hospital psychiatry 2014-11, Vol.36 (6), p.570-574
• Main Authors: Petersen, Juliana J., M.D., MPH, König, Jochem, Ph.D, Paulitsch, Michael A, Mergenthal, Karola, M.Sc. Public Health, Rauck, Sandra, Pagitz, Manuel, Schmidt, Konrad, M.D, Haase, Lydia, Gerlach, Ferdinand M., M.D., MPH, Gensichen, Jochen, M.D., MPH
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Antidepressive Agents - therapeutic use; Biological and medical sciences; Case Management; Cooperative Behavior; Depression; Depressive Disorder, Major - drug therapy; Family Practice - methods; Family Practice - statistics & numerical data; Female; Follow-Up Studies; Germany; Healthcare assistants; Humans; Linear Models; Logistic Models; Longitudinal Studies; Major depression; Male; Medical sciences; Medication Adherence; Mental Health Services - utilization; Middle Aged; Miscellaneous; Mood disorders; Outcome and Process Assessment (Health Care); Primary Health Care - utilization; Primary healthcare; Psychiatry; Psychiatry - methods; Psychiatry - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2014.07.006

Abstract Objective The aims of this study were (1) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes, and (2) to describe whether case management was continued after the end of the original one-year intervention. Methods This 24-month follow-up of a randomized controlled trial took place 12 months after the end of the 1-year intervention. Data collection occurred by means of self-rating questionnaires and from medical records. We calculated linear mixed and logistic generalized estimating equation models. Results Of the 626 patients included at baseline, 439 (70.1%) participated in this follow-up. Intervention recipients gave higher ratings than control recipients in terms of mean overall Patient Assessment of Chronic Illness Care (PACIC) scores (3.12 vs. 2.86; P = .019), but no difference was found in medication adherence (mean Morisky score 2.59 vs. 2.65, P = .56), prescribed antidepressant medications (60.2% vs. 55.1%; P = .25), visits to the family physician (15.96 vs. 14.46, P = .58) or mental health specialist (3.01 vs. 2.94, P = .94) over the 12 month follow-up period. Case management was continued for 47 (22.5%) selected intervention patients after the original intervention had ended. Conclusion At 24 months, intervention and control recipients had different PACIC ratings, but other process of care outcomes did not differ. Practice implications The main effects of the intervention are apparent at 12 months.