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Randomized Controlled Trial
. 2011 Nov 10:343:d6612.
doi: 10.1136/bmj.d6612.

Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial

Michael Von Korff  1 , Wayne J Katon, Elizabeth H B Lin, Paul Ciechanowski, Do Peterson, Evette J Ludman, Bessie Young, Carolyn M Rutter
Affiliations
Randomized Controlled Trial

Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial

Michael Von Korff et al. BMJ. .

Abstract

Objective: To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life.

Design: A randomised controlled trial of multi-condition collaborative care for depression and poorly controlled diabetes and/or risk factors for coronary heart disease compared with usual care among middle aged and elderly people

Setting: Fourteen primary care clinics in Seattle, Washington.

Participants: Patients with diabetes or coronary heart disease, or both, and blood pressure above 140/90 mm Hg, low density lipoprotein concentration >3.37 mmol/L, or glycated haemoglobin 8.5% or higher, and PHQ-9 depression scores of ≥ 10.

Intervention: A 12 month intervention to improve depression, glycaemic control, blood pressure, and lipid control by integrating a "treat to target" programme for diabetes and risk factors for coronary heart disease with collaborative care for depression. The intervention combined self management support, monitoring of disease control, and pharmacotherapy to control depression, hyperglycaemia, hypertension, and hyperlipidaemia.

Main outcome measures: Social role disability (Sheehan disability scale), global quality of life rating, and World Health Organization disability assessment schedule (WHODAS-2) scales to measure disabilities in activities of daily living (mobility, self care, household maintenance).

Results: Of 214 patients enrolled (106 intervention and 108 usual care), disability and quality of life measures were obtained for 97 intervention patients at six months (92%) and 92 at 12 months (87%), and for 96 usual care patients at six months (89%) and 92 at 12 months (85%). Improvements from baseline on the Sheehan disability scale (-0.9, 95% confidence interval -1.5 to -0.2; P = 0.006) and global quality of life rating (0.7, 0.2 to 1.2; P = 0.005) were significantly greater at six and 12 months in patients in the intervention group. There was a trend toward greater improvement in disabilities in activities of daily living (-1.5, -3.3 to 0.4; P = 0.10).

Conclusions: Integrated care that covers chronic physical disease and comorbid depression can reduce social role disability and enhance global quality of life. Trial registration Clinical Trials NCT00468676.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; WJK serves on boards for Eli Lilly and Wyeth and has given lectures for Eli Lilly, Wyeth, Forest, and Pfizer; EHBL serves on the board of the physician postgraduate press external advisory board, has given lectures for the University of Washington relevant to dissemination of the IMPACT and TEAMcare interventions, and developed a CME on adherence for Health Star Communications; PC is the founder of Samepage, an organisation that provides consultation and educational tools for improving patient-provider relationships.

Figures

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Disability and quality of life outcomes. Mean differences <0 on Sheehan disability scale and WHODAS-2 indicate reduced disability levels, while mean difference >0 on QOL measure indicates improved quality of life
See this image and copyright information in PMC

Comment in

References

    1. Gureje O. The pattern and nature of mental-physical comorbidity: specific or general. In: Von Korff M, Scott KM, Gureje O, eds. Global perspectives on mental-physical comorbidity in the WHO world mental health surveys. Cambridge University Press, 2009:51-83.
    1. Scott KM, Von Korff M, Alonso J, Angermeyer MC, Bromet E, Fayyad J, et al. Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys. Psychol Med 2008;26:1-11. - PMC - PubMed
    1. Von Korff M, Ormel J, Katon W, Lin EHB. Disability and depression in medical patients: a longitudinal analysis. Ach Gen Psychiatry 1992;49:91-100. - PubMed
    1. Ormel J, Von Korff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures: results from the WHO Collaborative Study on psychological problems in general health care. JAMA 1994;272:1741-8. - PubMed
    1. Von Korff M, Scott KM, Gureje O, eds. Global perspectives on mental-physical comorbidity in the WHO world mental health surveys. Cambridge University Press, 2009.

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