Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
J Gen Intern Med. 2023 May;38(7):1623-1630. doi: 10.1007/s11606-022-07958-8. Epub 2023 Jan 3.
BACKGROUND: Collaborative care (CC) is a multicomponent team-based approach to providing mental health care with systematic integration into outpatient medical settings. The 12-month INDEPENDENT CC intervention improved joint disease control measures in patients with both depression and diabetes at 12 and 24 months following randomization. OBJECTIVE: This study investigated the durability of intervention effects on patient outcomes at 36 months following randomization. PARTICIPANTS: Adult patients with poorly controlled T2D and depression in India randomized to CC or usual care. DESIGN: Post hoc analyses of between-group differences in patient outcomes at 36 months post-randomization (N = 331) and maintenance of outcomes from 12 to 36 months (N = 314). MAIN MEASURES: We evaluated combined risk factor improvement since baseline, defined as ≥ 50.0% reduction in Symptom Checklist Depression Scale (SCL-20) scores along with reduction of at least 0.5 percentage point hemoglobin A1C, 5 mmHg systolic blood pressure, or 10 mg/dL low-density lipoprotein cholesterol. Improvements in single risk factors were also examined. KEY RESULTS: There were no between-group differences in improvements since baseline in multiple or single risk factors at 36 months. Patients in the CC group with improved outcomes at 12 months were more likely to maintain a ≥ 50.0% reduction since baseline in SCL-20 scores (CC [54.9%] vs. UC [40.9%]; RR: 1.27 [95% CI: 1.04, 1.56]) and 0.5 percentage point reduction since baseline in hemoglobin A1C (CC [31.9%] vs. UC [19.5%]; RR: 1.64 [95% CI: 1.11, 2.41]) at 36 months. CONCLUSIONS: While improvements since baseline in patient outcomes did not differ between the collaborative care and usual care groups at 36 months, patients who received CC were more likely to maintain improvements in depressive symptoms and glucose levels at 36 months if they had achieved these improvements at the end of active intervention. TRIAL REGISTRATION NUMBER: NCT02022111.
背景:协作式护理(CC)是一种多组分的团队式方法,通过系统地将精神保健整合到门诊医疗环境中,为患者提供精神保健服务。为期 12 个月的独立 CC 干预措施在随机分组后 12 个月和 24 个月时改善了同时患有抑郁症和糖尿病患者的关节疾病控制措施。
目的:本研究旨在调查随机分组后 36 个月时干预对患者结局的持续效果。
参与者:在印度,患有未经控制的 2 型糖尿病且同时患有抑郁症的成年患者,随机分配至 CC 组或常规护理组。
设计:对随机分组后 36 个月(N=331)时患者结局的组间差异进行了事后分析,并对 12 至 36 个月期间结局的维持情况进行了分析(N=314)。
主要测量指标:我们评估了自基线以来的综合风险因素改善情况,定义为症状清单抑郁量表(SCL-20)评分降低≥50.0%,同时糖化血红蛋白降低至少 0.5 个百分点、收缩压降低 5mmHg 或低密度脂蛋白胆固醇降低 10mg/dL。还检查了单一风险因素的改善情况。
主要结果:在 36 个月时,多因素或单一风险因素的改善情况在 CC 组和 UC 组之间没有差异。在 12 个月时结局得到改善的 CC 组患者更有可能维持自基线以来 SCL-20 评分降低≥50.0%(CC [54.9%] vs. UC [40.9%];RR:1.27[95%CI:1.04,1.56])和血红蛋白 A1C 降低 0.5 个百分点(CC [31.9%] vs. UC [19.5%];RR:1.64[95%CI:1.11,2.41])。
结论:虽然在 36 个月时,CC 组和 UC 组患者的结局改善情况自基线无差异,但如果患者在积极干预结束时达到这些改善,则更有可能在 36 个月时维持抑郁症状和血糖水平的改善。
临床试验注册号:NCT02022111。
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