TY - JOUR
KW - Aged
KW - Blood Pressure
KW - China/epidemiology
KW - Comorbidity
KW - Cost-Benefit Analysis
KW - Depressive Disorder/epidemiology/therapy
KW - Disease Management
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Hypertension/epidemiology/therapy
KW - Patient Acceptance of Health Care
KW - Primary Health Care/methods
KW - Quality of Life
KW - Rural Population
KW - Treatment Outcome
KW - collaborative care
KW - Depression
KW - Hypertension
KW - older adults
KW - Rural China
AU - S. Chen
AU - Y. Conwell
AU - J. Xue
AU - L. W. Li
AU - W. Tang
AU - H. R. Bogner
AU - H. Dong
A1 - 
AB - BACKGROUND: Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. METHODS: The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village's Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects' electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. DISCUSSION: The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT01938963 ; First posted: September 10, 2013.
AD - Department of Psychology, Zhejiang University, Hangzhou, China.; Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, USA. Yeates_conwell@urmc.rochester.edu.; Department of Psychology, Zhejiang University, Hangzhou, China.; School of Social Work, University of Michigan, Ann Arbor, USA.; Department of Global Biostatistics and Data Science, Tulane University, New Orleans, USA.; Department of Family Medicine, University of Pennsylvania, Philadelphia, USA.; Faculty of Public Health Research, Zhejiang University, Hangzhou, China.
BT - BMC geriatrics
C5 - Financing & Sustainability; Healthcare Disparities
CP - 1
CY - England
DO - 10.1186/s12877-018-0808-1
IS - 1
JF - BMC geriatrics
M1 - Journal Article
N2 - BACKGROUND: Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. METHODS: The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village's Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects' electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. DISCUSSION: The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT01938963 ; First posted: September 10, 2013.
PP - England
PY - 2018
SN - 1471-2318; 1471-2318
SP - 018
EP - 1
EP - 124+
T1 - Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study
T2 - BMC geriatrics
TI - Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study
U1 - Financing & Sustainability; Healthcare Disparities
U2 - 29843644
U3 - 10.1186/s12877-018-0808-1
VL - 18
VO - 1471-2318; 1471-2318
Y1 - 2018
Y2 - May 29
ER -