title: Persistence in the long term of the effects of a collaborative care programme for depression in primary care.
abstract: BACKGROUND
  A collaborative care programme for depression in primary care has proven clinical effectiveness over a 12-months period. Because depression tends to relapse and to chronic course, our aim was to determine whether the effectiveness observed in the first year persists during 3 years of monitoring.
  
  
  METHODS
  Randomised controlled trial with twenty primary care centres were allocated to intervention group or usual care group. The intervention consisted of a collaborative care programme with clinical, educational and organisational procedures. Outcomes were monitored by a blinded interviewer at baseline, 12 and 36 months. Clinical outcomes were response to treatment and remission rates, depression severity and health-related quality of life.
  
  
  BACKGROUND
  ISRCTN16384353.
  
  
  RESULTS
  A total of 338 adult patients with major depression (DSM-IV) were assessed at baseline. At 36 months, 137 patients in the intervention group and 97 in the control group were assessed (attrition 31%). The severity of depression (mean Patient Health Questionnaire-9 score) was 0.95 points lower in the intervention group [6.31 versus 7.25; p=0.324]. The treatment response rate was 5.6% higher in the intervention group than in the control group [66.4% versus 60.8%; p=0.379] and the remission rate was 9.2% higher [57.7% versus 48.5%; p=0.164]. No difference reached statistical significance.
  
  
  CONCLUSIONS
  The number of patients lost (31%) before follow-up may have introduced a bias.
  
  
  CONCLUSIONS
  Clinical benefits shown in the first year were not maintained beyond: at 36 months the differences between the control group and the intervention group reduced in all the analysed variables.
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain. Electronic address: earagones.tarte.ics@gencat.cat.
authors.forename: Enric
authors.initials: E
authors.lastname: Aragonès
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Caballero
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain.
authors.forename: Josep-Lluís
authors.initials: JL
authors.lastname: Piñol
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: López-Cortacans
mesh_terms: D000293:Adolescent; D000328:Adult; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D013030:Spain
keywords: Collaborative care; Controlled clinical trial; Depression; Disease management; Primary health care