title: Collaborative care versus screening and follow-up for patients with diabetes and depressive symptoms: results of a primary care-based comparative effectiveness trial.
abstract: OBJECTIVE
  Depressive symptoms are common and, when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic patients.
  
  
  METHODS
  We conducted a controlled implementation trial in four nonmetropolitan primary care networks. Eligible patients had type 2 diabetes and screened positive for depressive symptoms, based on a Patient Health Questionnaire (PHQ) score of ≥10. Patients were allocated using an "on-off" monthly time series. Intervention consisted of case-managers working 1:1 with patients to deliver individualized care. The main outcome was improvement in PHQ scores at 12 months. A concurrent cohort of 71 comparable patients was used as nonscreened usual care control subjects.
  
  
  RESULTS
  Of 1,924 patients screened, 476 (25%) had a PHQ score >10. Of these, 95 were allocated to intervention and 62 to active control. There were no baseline differences between groups: mean age was 57.8 years, 55% were women, and the mean PHQ score was 14.5 (SD 3.7). Intervention patients had greater 12-month improvements in PHQ (7.3 [SD 5.6]) compared with active-control subjects (5.2 [SD 5.7], P = 0.015). Recovery of depressive symptoms (i.e., PHQ reduced by 50%) was greater among intervention patients (61% vs. 44%, P = 0.03). Compared with trial patients, nonscreened control subjects had significantly less improvement at 12 months in the PHQ score (3.2 [SD 4.9]) and lower rates of recovery (24%, P < 0.05 for both).
  
  
  CONCLUSIONS
  In patients with type 2 diabetes who screened positive for depressive symptoms, collaborative care improved depressive symptoms, but physician notification and follow-up was also a clinically effective initial strategy compared with usual care.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada jeff.johnson@ualberta.ca.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Fatima
authors.initials: F
authors.lastname: Al Sayah
authors.affiliation: Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wozniak
authors.affiliation: Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rees
authors.affiliation: Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Soprovich
authors.affiliation: Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Weiyu
authors.initials: W
authors.lastname: Qiu
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Constance L
authors.initials: CL
authors.lastname: Chik
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chue
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Florence
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jacquier
authors.affiliation: Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Pauline
authors.initials: P
authors.lastname: Lysak
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Opgenorth
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D000328:Adult; D000368:Aged; D019058:Community Networks / Q000458:organization & administration; D057186:Comparative Effectiveness Research; D003266:Continuity of Patient Care / Q000458:organization & administration; D003299:Cooperative Behavior; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D057285:Precision Medicine / Q000379:methods; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration