Graduate mental health worker case management of depression in UK primary care: a pilot study

Abstract

Background: Based on data from large multicentre US trials, the National Institute for Health and Clinical Excellence (NICE) is advocating a stepped-care model for the management of depression, with 'case management' or 'collaborative care' for selected patients in primary care.

Aim: To conduct a pilot study examining the use of graduate mental health workers case managing depressed primary care NHS patients.

Design of study: A randomised controlled trial comparing usual GP care with or without case management over 16 weeks of acute antidepressant drug treatment.

Setting: Three primary care practices in the North East of England.

Method: Patients with depression, aged 18-65 years, who had failed to adequately respond to antidepressant treatment, were randomised to the two treatments. Assessments were made at baseline, 12, and 24 weeks using a combination of observer and self ratings.

Results: Randomisation of 62 patients required screening of 1073 potential patients. There was little difference in outcome between the two treatment arms but a gradual improvement in symptoms over time was seen. Client satisfaction was assessed as high across both treatments.

Conclusion: While this pilot study confirmed the integrity of the study protocol and the suitability of the outcome measures and randomisation procedure, it raises questions regarding the practicality of recruitment and feasibility of the intervention. It would be crucial to address these issues prior to the implementation of a large multi-centre randomised controlled trial.

Figure 1

Consort diagram of patient flow through trial.