Impact of telephone delivered case-management on the effectiveness of collaborative care for depression and anti-depressant use: A systematic review and meta-regression

Abstract

Background The health service delivery framework collaborative care is an effective intervention for depression. However, uncertainties remain about how to optimise its delivery at scale. Structured case management is a core component of collaborative care; its delivery via the telephone may improve access. Aims To examine using meta-regression if telephone delivered case management diminishes the clinical effectiveness of collaborative care on depressive symptoms and anti-depressant use relative to face-to-face delivery methods. Methods Randomised controlled trials were eligible if they included collaborative care interventions for adults with depression identified using self-report measures or diagnostic interviews and reported depression outcomes. Sociodemographics, intervention characteristics, depressive symptoms, and anti-depressant use were extracted. Random effects univariable and multivariable meta-regression analyses were used to examine the moderating effect of telephone delivered case-management on outcomes. Results Ninety-four trials were identified comprising of 103 comparisons across 24, 132 participants with depression outcomes and 67 comparisons from 15,367 participants with anti-depressant use outcomes. Telephone delivered case management did not diminish the effects of collaborative care on depressive symptoms (β = -0.01, 95% CI -0.12 to 0.10; p = 0.86). Telephone delivered case management decreased anti-depressant medication use (relative risk 0.76, 95% CI 0.63 to 0.92; p = 0.005); this effect remained when assessed simultaneously alongside other study-level moderators of collaborative care. Conclusion Using remote platforms such as the telephone to deliver case management may be a feasible way to implement collaborative care with no loss of effectiveness on depressive symptoms. However, adherence to anti-depressant medication may decrease when telephone case management is used.

A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service

“…Although there is a large literature indicating the difficulties in implementing and sustaining new practices and technologies in healthcare [35, 36] evidence exists to demonstrate the potential for clinical and cost effectiveness of telephone treatment [15]. A recent systematic review and meta-analysis of the impact of telephone delivered case management for depression in collaborative care demonstrated no loss of effectiveness compared to face to face case management [37] which supports our findings for the drivers for the provision of telephone treatment in IAPT. In addition, a study of patient acceptability of telephone CBT for widespread pain highlighted similar considerations around acceptance and the benefits of telephone treatment for managing felt stigma [38].…”

What influences practitioners’ readiness to deliver psychological interventions by telephone? A qualitative study of behaviour change using the Theoretical Domains Framework

“…It is also an accessible, National Institute for Health and Care Excellence (NICE)-recommended treatment option for mild to moderate depression and anxiety in routine practice [8,9]. Systematic reviews demonstrate comparable effectiveness between [10][11][12][13], and adherence to [13], psychological treatments delivered by telephone and face-to-face, with robust analyses demonstrating the cost-effectiveness of telephone delivery [11,14,15].…”

Types of Utilization and Types of Treatment Response in a Collaborative Care Approach for Depressive Disorders in Old Age in Primary Care

“…This complex intervention, which was carried out over 1 year, was superior to TAU; 25.6% of the intervention group showed a remission of depressive symptoms compared with 10.9% of TAU (16). This result is comparable with the original US study (17), as well as with other international adaptations (18). Nevertheless, three-quarters of the patients in the intervention group did not respond to the therapy support and did not achieve a satisfactory reduction in depression.…”

“…The results were generated in the context of the German health care system by using an intervention that has already tested itself internationally in different ways (18). Nevertheless, the German problems of time pressure in primary care, latency for specialized therapeutic care of depression, and selfstigmatization associated with special mental health care are international phenomena as well (61).…”