Effectiveness of Collaborative Stepped Care for Anxiety Disorders in Primary Care: A Pragmatic Cluster Randomised Controlled Trial

Muntingh, Anna; Feltz-Cornelis, Christina M. van der; Marwijk, Harm van; Spinhoven, Philip; Assendelft, W.J.J.; Waal, Margot de; Adèr, H.J.; Balkom, Anton van

doi:10.1159/000353682

Cited by 55 publications

(55 citation statements)

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“…The majority of collaborative care trials have been carried out in a health-care setting and they tend to be targeted at depression and anxiety disorders 32,[41][42][43][44][45][46][47][48] (Table 2). Accordingly, most outcomes were condition-specific measures.…”

Section: Summary Of the Results Of The Reviewmentioning

confidence: 99%

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

et al. 2018

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BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.

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Section: Summary Of the Results Of The Reviewmentioning

confidence: 99%

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

et al. 2018

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“…Ongeveer tien tot twintig procent van de patiënten met een angststoornis heeft niet voldoende aan de begeleide zelfhulp en heeft aanvullende behandeling nodig. 20 De ervaring leert dat CGT alleen goed is toe te passen door een POH-GGZ die een aanvullende opleiding in de CGT heeft gedaan en toegang heeft tot een CGT-supervisor. Een derde functie van de consulent is de signaalfunctie.…”

Section: Casus: Collaborative Care In De Prakijkunclassified

Collaborative care in de huisartspraktijk

Huijbregts¹,

Muntingh²

2015

PSYCHOPRAKTIJK

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“…More recent studies expand the collaborative care intervention to patients with anxiety disorders (Muntingh et al, 2014) and substance use disorder (Alford et al, 2011). In addition to targeting depression, collaborative care interventions have also been used to simultaneously treat co-morbid medical diagnoses (e.g.…”

Section: Integrated Care In Outpatient Primary and Specialist Medicalmentioning

confidence: 99%

What is integrated care?

Huang

Meller

Kishi

et al. 2014

International Review of Psychiatry

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Increasing awareness of mental illness's impact on medical and psychiatric health has accelerated global efforts to integrate medical and behavioural health services. As the field of integration has advanced, numerous integrated programmes have been implemented. In examining the impact of these programmes, it is important to maintain a standardized vocabulary to describe the various components of their integration. Additionally important is examination of how these programmes impact elements of patient care and the healthcare system. Specifically, what value do they bring? This article will discuss the importance of carefully assessing the value integrated services bring to patients, and questioning whether they do so in ways in which today's segregated world of medical and behavioural health cannot. This article will also explore the various settings in which medical and behavioural integration can bring added value.

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Effectiveness of Collaborative Stepped Care for Anxiety Disorders in Primary Care: A Pragmatic Cluster Randomised Controlled Trial

Cited by 55 publications

References 34 publications

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

Collaborative care in de huisartspraktijk

What is integrated care?

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