title: Effectiveness of collaborative care for depression in Italy. A randomized controlled trial.
abstract: METHODS
  This was a multicenter cluster-randomized controlled trial.
  
  
  METHODS
  A total of 227 patients ≥18 years old with a new onset of depressive symptoms who screened positive on the first two items of the Patient Health Questionnaire-9 (PHQ-9) were recruited by primary care physicians (PCPs) of eight health districts of three Italian regions from September 2009 to June 2011.
  
  
  METHODS
  PCPs of the intervention group received a specific collaborative care program including 2 days of intensive training, implementation of a stepped care protocol, depression management toolkit and scheduled meetings with a dedicated consultant psychiatrist.
  
  
  OBJECTIVE
  The objective was to determine whether a collaborative care program for depression management in primary care leads to higher remission rate than usual PCP care.
  
  
  RESULTS
  Outcome was clinical remission as expressed on PHQ-9 <5 at 3 months.
  
  
  METHODS
  An independent researcher used computer-generated randomization to assign involved primary care groups to the two alternative arms.
  
  
  METHODS
  PCPs and research personnel were not blinded.
  
  
  RESULTS
  The 223 PCPs enrolled recruited 227 patients (128 in collaborative care arm, 99 in the usual care arm). At 3 months (n=210), the proportion of patients who achieved remission was higher, though the difference was not statistically significant, in the collaborative care group. The effect size was of 0.11. When considering only patients with minor/major depression, collaborative care appeared to be more effective than usual care (P=.015).
  
  
  CONCLUSIONS
  The present intervention for managing depression in primary care, designed to be applicable to the Italian context, appears to be effective and feasible.
authors: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: marco.menchetti3@unibo.it.
authors: Marco
authors: M
authors: Menchetti
authors: Cecilia
authors: C
authors: Sighinolfi
authors: Vittorio
authors: V
authors: Di Michele
authors: Paolo
authors: P
authors: Peloso
authors: Claudia
authors: C
authors: Nespeca
authors: Pier Venanzio
authors: PV
authors: Bandieri
authors: Maria
authors: M
authors: Bologna
authors: Angelo
authors: A
authors: Fioritti
authors: Roberta
authors: R
authors: Fravega
authors: Lucio
authors: L
authors: Ghio
authors: Simona
authors: S
authors: Gotelli
authors: Paolo
authors: P
authors: Levantesi
authors: Maria Amparo
authors: MA
authors: Ortega
authors: Micaela
authors: M
authors: Savorani
authors: Luigi
authors: L
authors: Simoni
authors: Ilaria
authors: I
authors: Tarricone
authors: Mara
authors: M
authors: Morini
authors: Linda
authors: L
authors: Gask
authors: Domenico
authors: D
authors: Berardi
mesh_terms: D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003863:Depression / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000379:methods*; D011570:Psychiatry / Q000193:education / Q000379:methods*; D012017:Referral and Consultation; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome
keywords: Collaborative care; Depression; Primary care; Primary care physician; Usual care