Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Health Service and Systems Research, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
Int J Geriatr Psychiatry. 2020 Oct;35(10):1171-1180. doi: 10.1002/gps.5353. Epub 2020 Jun 4.
The effectiveness and portability of the collaborative care model in the primary care treatment of depression has not been demonstrated in many randomized controlled trials in healthcare settings across the world. We determined the effectiveness of collaborative care management of elderly depression in the primary care setting in Singapore.
Eligible participants with depressive symptoms were randomized to 6-month duration usual care (UC, N = 112) or collaborative care (CC, N = 102). Outcome measures were HDRS-17, GDS, BDI and SF-12 MCS QOL measured at 3, 6, and 12-month, care satisfaction at 6-month, and also measured on 120 participants who refused referral (non-receipt of care, NC). Primary outcome was HDRS-17 measure of depression severity, response and remission at 6-month.
HDRS scores in CC group compared to UC group were reduced more at 6-month (1.5 points difference in change from baseline), and also at 3 and 12-month, with similar observations of differences for GDS and BDI. There was significantly greater improvement for both CC and UC groups compared to NC group. The CC group was about 1.5 times more likely to show HDRS treatment response and remission, and more than two times likely to show GDS treatment response and remission than the UC and NC groups, as well as better quality of life improvement (P < .001) and better care satisfaction (P < .001).
Collaborative care is effective for primary care treatment of older persons with depression and is portable in diverse health care settings.
协作式护理模式在全球范围内的医疗保健环境中的许多随机对照试验中并未显示出在初级保健治疗抑郁症方面的有效性和便携性。我们在新加坡的初级保健环境中确定了协作式护理管理老年抑郁症的有效性。
符合条件的有抑郁症状的参与者被随机分配到 6 个月的常规护理（UC，N=112）或协作式护理（CC，N=102）。结局指标包括在 3、6 和 12 个月时的 HDRS-17、GDS、BDI 和 SF-12 MCS QOL，在 6 个月时的护理满意度，以及在 120 名拒绝转介的参与者（未接受护理，NC）上的测量。主要结局是 6 个月时 HDRS-17 测量的抑郁严重程度、反应和缓解。
CC 组与 UC 组相比，HDRS 评分在 6 个月时（从基线变化的 1.5 分差异），以及在 3 个月和 12 个月时都有所降低，GDS 和 BDI 的差异也有类似的观察结果。CC 和 UC 组的改善均明显大于 NC 组。与 UC 和 NC 组相比，CC 组更有可能出现 HDRS 治疗反应和缓解，出现 GDS 治疗反应和缓解的可能性高出两倍以上，生活质量改善（P<.001）和护理满意度（P<.001）更好。
协作式护理对老年人抑郁症的初级保健治疗有效，并且在不同的医疗保健环境中具有可移植性。
