Mood Disorders Centre, School of Psychology, University of Exeter, EX4 4QG, UK.
BMC Health Serv Res. 2009 Oct 16;9:188. doi: 10.1186/1472-6963-9-188.
Comprising of both organisational and patient level components, collaborative care is a potentially powerful intervention for improving depression treatment in UK primary Care. However, as previous models have been developed and evaluated in the United States, it is necessary to establish the effect of collaborative care in the UK in order to determine whether this innovative treatment model can replicate benefits for patients outside the US. This Phase III trial was preceded by a Phase II patient level RCT, following the MRC Complex Intervention Framework.
METHODS/DESIGN: A multi-centre controlled trial with cluster-randomised allocation of GP practices. GP practices will be randomised to usual care control or to "collaborative care" - a combination of case manager coordinated support and brief psychological treatment, enhanced specialist and GP communication. The primary outcome will be symptoms of depression as assessed by the PHQ-9.
If collaborative care is demonstrated to be effective we will have evidence to enable the NHS to substantially improve the organisation of depressed patients in primary care, and to assist primary care providers to deliver a model of enhanced depression care which is both effective and acceptable to patients.
协作式护理由组织层面和患者层面的多个部分组成，是一种提高英国初级保健中抑郁治疗效果的强大干预手段。然而，由于之前的模式是在美国开发和评估的，因此有必要在英国确定协作式护理的效果，以确定这种创新的治疗模式是否可以在美国以外的地区为患者带来益处。本项 III 期试验之前进行了一项 II 期患者层面 RCT，遵循 MRC 综合干预框架。
方法/设计：这是一项多中心、以全科医生实践为单位的对照试验，采用集群随机分组方法。全科医生实践将被随机分配到常规护理对照组或“协作式护理组”——由病例经理协调的支持和简短心理治疗相结合，加强专家和全科医生的沟通。主要结局指标将是 PHQ-9 评估的抑郁症状。
如果协作式护理被证明有效，我们将有证据使国民保健制度能够大大改善初级保健中抑郁患者的组织管理，并帮助初级保健提供者提供一种既有效又能被患者接受的强化抑郁护理模式。
