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Practice nurse-led proactive care for chronic depression in primary care: A randomised controlled trial

  • Marta Buszewicz (a1), Mark Griffin (a1), Elaine M. McMahon (a1), Kate Walters (a1) and Michael King (a2)...

Abstract

Background

Management of long-term depression is a significant problem in primary care populations with considerable on-going morbidity, but few studies have focused on this group.

Aims

To evaluate whether structured, nurse-led proactive care of patients with chronic depression in primary care improves outcomes.

Method

Participants with chronic/recurrent major depression or dysthymia were recruited from 42 UK general practices and randomised to general practitioner (GP) treatment as usual or nurse intervention over 2 years (the ProCEED trial, trial registration: ISRCTN36610074).

Results

In total 282 people received the intervention and there were 276 controls. At 24 months there was no significant improvement in Beck Depression Inventory (BDI-II) score or quality of life (Euroquol-EQ-VAS), but a significant improvement in functional impairment (Work and Social Activity Schedule, WSAS) of 2.5 (95% CI 0.6–4.3, P = 0.010) in the intervention group. The impact per practice-nurse intervention session was –0.37 (95% CI –0.68 to –0.07, P = 0.017) on the BDI-II score and –0.33 (95% CI –0.55 to –0.10, P = 0.004) on the WSAS score, indicating that attending all 10 intervention sessions could lead to a BDI-II score reduction of 3.7 points compared with controls.

Conclusions

The intervention improved functioning in these patients, the majority of whom had complex long-term difficulties, but only had a significant impact on depressive symptoms in those engaging with the full intervention.

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Copyright

Corresponding author

Marta Buszewicz, MBBS, MRCGP, MRCPsych, Research Department of Primary Care & Population Health, University College London (Royal Free Campus), Upper 3rd Level Rowland Hill Street, London NW3 2PF, UK. Email: m.buszewicz@ucl.ac.uk

Footnotes

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This work was funded by The Big Lottery – grant code RG/1/010166750. We also received the service support costs for which the study was eligible from the Department of Health. The study sponsor was University College London. Neither the sponsor nor the funder had any role in the study design, data collection, data analysis and interpretation, writing of the report or decision to submit for publication.

Declaration of interest

None.

Footnotes

References

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1 Murray, CJL, Lopez, AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. World Health Organization, 1996.
2 Wells, KB, Stewart, A, Hays, RD, Burnam, A, Rogers, W, Daniels, M, et al. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA 1989; 262: 914–9.
3 Wells, KB, Burnam, MA, Rogers, W, Hays, R, Camp, P. The course of depression in adult outpatients. Results from the Medical Outcomes Study. Arch Gen Psychiatry 1992; 49: 788–94.
4 Conradi, HJ, de Jonge, P, Ormel, J. Prediction of the three-year course of recurrent depression in primary care patients: different risk factors for different outcomes. J Affect Disord 2008; 105: 267–71.
5 Lloyd, KR, Jenkins, R, Mann, A. Long term outcome of patients with neurotic illness in general practice. BMJ 1996; 313: 26–8.
6 Arroll, B, Moir, F. Time for a rethink of treatment for patients with depression in primary care. Br J Gen Pract 2010; 60: 641–2.
7 Katon, W, Robinson, P, Von Korff, M, Lin, E, Bush, T, Ludman, E, et al. A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry 1996; 53: 924–32.
8 Simon, GE, Katon, WJ, VonKorff, M, Unützer, J, Lin, EH, Walker, EA, et al. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry 2001; 158: 1638–44.
9 Katon, WJ, Rutter, C, Ludman, E, von Korff, M, Lin, E, Simon, G, et al. A randomised trial of relapse prevention of depression in primary care. Arch Gen Psychiatry 2001; 58: 241–7.
10 Rost, K, Nutting, P, Smith, JL, Elliott, CE, Dickinson, M. Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. BMJ 2003; 325: 934.
11 Gilbody, S, Bower, P, Fletcher, J, Richards, D, Sutton, A. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006; 166: 2314–21.
12 Buszewicz, M, Griffin, M, McMahon, E, Beecham, J, King, M. Randomised controlled trial of structured, proactive nurse-led care for chronic depression in primary care: the ProCEED trial. BMC Psychiatry 2010; 10: 61.
13 Kessler, RC, Abelson, J, Demler, O, Escobar, JI, Gibbon, M, Guyer, ME, et al. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI). Int J Methods Psychiatr Res 2004; 13: 122–39.
14 Arnau, R, Meagher, MW, Norris, MP, Bramson, R. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol 2001; 20: 112–9.
15 Mynors-Wallis, LM, Gath, DH, Day, A, Baker, F. Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for depression in primary care. BMJ 2000; 320: 2630.
16 Rollnick, S, Heather, N, Bell, A. Negotiating behaviour change in medical settings: the development of brief motivational interviewing. J Ment Health 1992; 1: 2537.
17 Mundt, JC, Marks, IM, Shear, MK, Greist, JM. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry 2002; 180: 461–4.
18 Brooks, R. EuroQol: the current state of play. Health Policy 1995; 37: 5372.
19 King, M, Davidson, O, Taylor, F, Haines, A, Sharp, D, Turner, R. Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial. BMJ 2002; 324: 947.
20 Rabe-Hesketh, S, Skrondal, A. Multilevel and Longitudinal Modelling using Stata (2nd edn). Stata Press, 2008.
21 Vickers, AJ, Altman, DG. Analysing controlled trials with baseline and follow up measurements. BMJ 2001; 323: 1123–4.
22 Hedges, LV. Distribution theory for Glass's estimator of effect size and related estimators. J Educ Behav Statist 1981; 6: 107–28.
23 Sussman, J, Hayward, R. Using instrumental variables to adjust for treatment contamination in randomised controlled trials. BMJ 2010; 340: 1181–84.
24 Edwards, PJ, Roberts, IG, Clarke, MJ, DiGuiseppi, C, Wentz, R, Kwan, I, et al. Methods to increase response rates to postal questionnaires. Cochrane Library 2009; 3: MR000008.
25 McMahon, EM, Buszewicz, M, Griffin, M, Beecham, J, Bonin, E, Rost, F, et al. Chronic and recurrent depression in primary care: socio-demographic features, morbidity and costs. Int J Fam Med 2012; 2012: 316409.
26 Health and Social Care Information Centre. Trends in Consultation Rates in General Practice – 1995–2009. Health and Social Care Information Centre, 2009 (http://www.hscic.gov.uk/pubs/gpcons95-09).
27 Wagner, EH, Austin, BT, Von Korff, M. Organising care for patients with chronic illness. Millbank Q 1996; 74: 511–44.
28 Bodenheimer, T, MacGregor, K, Stothart, N. Nurses as leaders in chronic care. BMJ 2005; 330: 612–3.
29 Crosland, A, Kai, J. They think they can talk to nurses: practice nurses' views of their roles in caring for mental health problems. Br J Gen Pract 1998; 48: 1383–6.
30 Christensen, H, Griffiths, K, Gulliver, A, Clack, D, Kljakovic, , Wells, L. Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials. BMC Fam Pract 2008; 9: 25.
31 Bennett, M, Walters, K, Drennan, V, Buszewicz, M. Structured proactive care for chronic depression by practice nurses in primary care: a qualitative evaluation. PLoS One 2013; 8: e75810.
32 Mintz, J, Mintz, LI, Arruda, MJ, Hwang, SS. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry 1992; 49: 761–8.
33 Greer, TL, Kurian, BT, Trivedi, MH. Defining and measuring functional recovery from depression. CNS Drugs 2010; 24: 267–84.
34 McKnight, PE, Kashdan, TB. The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev 2009: 29: 243.
35 Buszewicz, M, Griffin, M, Beecham, J, Bonin, E, Hutson, M. ProCEED. Report of a Study of Pro-Active Care by Practice Nurses for People with Anxiety and Depression. Mind Publications, 2011.

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Practice nurse-led proactive care for chronic depression in primary care: A randomised controlled trial

  • Marta Buszewicz (a1), Mark Griffin (a1), Elaine M. McMahon (a1), Kate Walters (a1) and Michael King (a2)...

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Practice nurse-led proactive care for chronic depression in primary care: A randomised controlled trial

  • Marta Buszewicz (a1), Mark Griffin (a1), Elaine M. McMahon (a1), Kate Walters (a1) and Michael King (a2)...
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