| Why is collaborative care important? Collaborative care includes care provided by both a primary physician and a psychiatrist and includes a multi-professional approach to patient care, a structured management plan, scheduled follow ups, and inter-professional communication. Case management involves a health worker taking responsibility for follow up care to assess patient adherence to treatment, monitor progress, and take action when treatments are unsuccessful. Does collaborative care work? - Collaborative care is effective for adults with depression, anxiety, or both at 6 months, 12 months, and 24 months.
Equity: does collaborative care work in the disadvantaged? - Collaborative care may be effective in the disadvantaged by increasing contact with health care professionals who are committed to active follow up. However, only one study was conducted in a low income country and this study found that collaborative care had little to no difference in depression outcomes.
Intervention Delivery - The interventions included 4 components: multi-professional approach to patient care (primary care provider and at least one other health professional or paraprofessional), structured management plan, scheduled patient follow-up, enhanced inter-professional communication
Population and Setting - Participants had been diagnosed with depression, anxiety, or both and the intervention was effective in adults over 18 years old
- 79 studies were included. Studies were conducted in the UK, US, Germany, the Netherlands, Canada, Chile, India, and Puerto Rico, almost all of which are high-income countries.
- Participants were recruited from primary care, community, specialist physical health, or a mixture of these settings.
Summary of Findings [SOF] Tables: Collaborative care for depression and anxiety Patient or population: Adults
Settings: Primary care, community, specialist or physical health settings
Intervention: Collaborative care
Comparison: Usual care | Outcomes | | Anticipated absolute effects per year | Risk Ratio
(95% CI) | No of Participants
(studies) | Quality of the evidence
(GRADE) | | | | Risk without collaborative care (Control) | Risk difference with collaborative care (95% CI) | | | | | Depression Response | | | 0 to 6 months | | 54 per 100 | 17 more per 100 (from 11 to 23 more) | RR 1.32 (1.22 - 1.43) | 11249 (48) | Moderate1 | | 7 to 12 months | | 53 per 100 | 17 more per 100 (9 to 26 more) | RR 1.31 (1.17 - 1.48) | 8001 (29) | Moderate2 | | 13 to 24 months | | 46 per 100 | 14 more per 100 (from 9 to 19 more) | RR 1.29 (1.18 t -1.41) | 2983 (6) | High | | Anxiety Response | | 0 to months | | 35 per 100 | 18 more (from 8 to 31 more) | RR 1.50 (1.21 - 1.87) | 1248 (4) | Moderate3 | | 7 to 12 months | | 40 per 100 | 17 more (from 8 to 28 more) | RR 1.41 (1.18-1.69) | 1374 (5) | Moderate4 | | 13 to 24 months | | 50 per 100 | 13 more (from 5 to 15 more) | RR 1.26 (1.11-1.42) | 804 (1) | Moderate5 | RR=risk ratio CI=confidence interval | | Adverse Events: None reported |
1. High heterogeneity (I2= 71%) 2. High heterogeneity (I2= 83%) 3. Wide confidence interval 4. Wide confidence interval 5. Only one study assessed anxiety at 13-24 months. Wide confidence interval | Relevance of the review for disadvantaged communities
Collaborative care improves depression and anxiety outcomes.
Collaborative care would may be effective in the disadvantaged by increasing contact with health care professionals who are committed to active follow up.
| | Findings | Interpretation | | Equity - Which of the PROGRESS groups examined | | Participants in the included studies were adolescents under the age of 18, adults between 18 and 64, and adults over 65. Almost 20% of studies included participants with a physical comorbidity, such as diabetes, cancer, and epilepsy. The results were not significant for adolescents. Patients with other mental health conditions of addictions to alcohol were excluded. | The results appear to be generalizable to adults diagnosed with depression, with or without a comorbidity but may not be generalizable to low resource settings. Future trials should examine whether collaborative care is effective for other mental health conditions. | | Equity Applicability | | All but one of the included studies was conducted in high-income countries and 76% were conducted in the US. | The results of the review may by applicable in low-income countries but only one included study was conducted in a low- and middle-income country (India). This study found that collaborative care had little to no difference in depression outcomes. Future trials should examine the effectiveness of collaborative care in lower resource settings. | | The interventions in the included studies met the following criteria: - Multi-professional approach including both a primary care provider and at least one other health professional or paraprofessional. - Structured management plan including access to evidence based management information and including management of both pharmacological and non-pharmacological interventions. - Scheduled follow-up with the patient including both in-person and telephone appointments. - Inter-professional communication between those caring for the patient including case conferences, shared medical records and feedback between caregivers. | Collaborative care is a complex intervention that requires commitment from a team of health care providers. Policy makers need to ensure that health care providers are willing and able to follow through with the 4 components of collaborative care to ensure the intervention is effective. The intervention requires that health care professionals have the time required to communicate and follow up with both with colleagues as well as their patients. | | Cost-equity | | The review does not report on the cost-effectiveness of collaborative care. | Policymakers need to consider the costs of collaborative care which may include the costs of additional follow up visits and | | Monitoring & Evaluation for PROGRESS groups | | Collaborative care was found to be effective at improving depression and anxiety outcomes in the short and medium term. | Further studies should assess collaborative care’s effectiveness long term and among different age groups such as adolescents under 18 years old and seniors over 65. |
Comments on this summary? Please contact Jennifer Petkovic. |
