Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial

Björkelund, Cecilia; Svenningsson, Irene; Hange, Dominique; Udo, Camilla; Petersson, Eva‐Lisa; Ariai, Nashmil; Nejati, Shabnam; Wessman, Catrin; Wikberg, Carl; André, M; Wallin, Lars; Westman, Jeanette

doi:10.1186/s12875-018-0711-z

Cited by 49 publications

(90 citation statements)

References 27 publications

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“…This is a qualitative study where individual face‐to‐face interviews were conducted and analysed using systematic text condensation in accordance with Malterud (). The study is a qualitative follow‐up of a cluster randomized intervention, previously described by Björkelund et al (), where a CM organization for patients with depression was implemented and evaluated for the first time in Swedish primary care settings. Promising quantitative results from the intervention have previously been reported about reduced depression symptoms, improved quality of life and return to work for patients with a CM contact (Björkelund et al, ).…”

Section: The Studymentioning

confidence: 99%

“…The study is a qualitative follow‐up of a cluster randomized intervention, previously described by Björkelund et al (), where a CM organization for patients with depression was implemented and evaluated for the first time in Swedish primary care settings. Promising quantitative results from the intervention have previously been reported about reduced depression symptoms, improved quality of life and return to work for patients with a CM contact (Björkelund et al, ). In addition, a qualitative follow‐up showed that nurses/district nurses working as CMs perceived their work as more meaningful and empowering when able to provide care continuity and accessibility to patients with depression (Svenningsson et al, ).…”

Section: The Studymentioning

confidence: 99%

“…They had been in regular contact with a specially trained CM for 3 months as an addition to their care as usual (CAU), that is, cognitive behavioural therapy (CBT), interpersonal therapy and/or antidepressants, in accordance with The Swedish National Guidelines for Depression and Anxiety Disorders (The Swedish National Board of Health & Welfare, ). Their contact with the CM followed a structured protocol based on an initial 1‐hr dialogue at the PCC, followed by 6–8 scheduled telephone contacts (each lasted around 15–30 min) within 3 months (Björkelund et al, ; Svenningsson et al, ). Every telephone contact started with the patient filling out the self‐assessment instrument MADRS‐S (Montgomery Asberg Depression Rating Scale – self‐rating version; Svanborg & Asberg, ).…”

Section: The Studymentioning

confidence: 99%

“…The participants recruited to this study had all been in contact with a CM at one of the PCCs where a CM organization was implemented. When they first agreed to take part in the intervention study evaluating CMs at PCCs (Björkelund et al, ), they were also verbally informed that they might be asked to participate in an interview later, where their experiences of having contact with a CM would be the focus. When filling out the instruments at the 3‐month follow‐up, the first 20 participants were asked, face‐to‐face, if they were interested in taking part in an interview.…”

Section: The Studymentioning

confidence: 99%

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An interview study of the care manager function—Opening the door to continuity of care for patients with depression in primary care

et al. 2019

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Aim To explore experiences among patients with depression of contact with a care manager at a primary care centre. Design A qualitative explorative study. Methods During spring and summer 2016, 20 individual face‐to‐face interviews were conducted with patients with experience of care manager contact. The material was analysed using systematic text condensation. Results The participants described that having contact with a care manager was a support in their recovery process. Care became more available, and the structured continuous contact and the care manager's availability contributed to a trusting relationship. Having someone to share their burden with was a relief. However, it was described as negative when the care manager was perceived as inflexible and not open to issues that the participants felt a need to discuss. For the care manager contact to be successful, there is a need for flexibility and individually tailored contact.

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Section: The Studymentioning

confidence: 99%

Section: The Studymentioning

confidence: 99%

Section: The Studymentioning

confidence: 99%

Section: The Studymentioning

confidence: 99%

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An interview study of the care manager function—Opening the door to continuity of care for patients with depression in primary care

et al. 2019

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“…While a strong body of evidence has supported the integration of behavioral health services into primary care to treat depression [17][18][19][20][21], anxiety [22,23], and chronic health conditions [24,25], no randomized control trials (RCTs) have investigated the efficacy of integrated services for refugee populations. Few trials exist in the field of refugee health due to the ethical and practical challenges of conducting experimental research with this population [26,27].…”

Section: Introductionmentioning

confidence: 99%

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial

et al. 2020

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Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression.Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n = 112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n = 102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P < .001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P < .001).Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

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Key Components of Effective Pediatric Integrated Mental Health Care Models

et al. 2020

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IMPORTANCEEmerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children Յ12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined.OBJECTIVE To identify and describe the key components of effective pediatric integrated mental health care models. EVIDENCE REVIEWThe PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019.FINDINGS Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment. CONCLUSIONS AND RELEVANCEThis review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.

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Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial

Cited by 49 publications

References 27 publications

An interview study of the care manager function—Opening the door to continuity of care for patients with depression in primary care

An interview study of the care manager function—Opening the door to continuity of care for patients with depression in primary care

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial

Key Components of Effective Pediatric Integrated Mental Health Care Models

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