TY - JOUR
KW - Activities of Daily Living
KW - Aged
KW - Coronary Disease/complications/epidemiology/therapy
KW - Delivery of Health Care, Integrated/methods
KW - Depression/complications/epidemiology/therapy
KW - Diabetes Mellitus/epidemiology/therapy
KW - Disability Evaluation
KW - Female
KW - Hemoglobins/analysis
KW - Humans
KW - Hyperlipidemias/complications/epidemiology/therapy
KW - Hypertension/complications/epidemiology/therapy
KW - Lipoproteins, LDL/blood
KW - Male
KW - Middle Aged
KW - Quality of Life
KW - Regression Analysis
KW - Risk Factors
KW - Self Care
KW - Treatment Outcome
KW - Washington/epidemiology
AU - M. Von Korff
AU - W. J. Katon
AU - E. H. Lin
AU - P. Ciechanowski
AU - D. Peterson
AU - E. J. Ludman
AU - B. Young
AU - C. M. Rutter
A1 - 
AB - 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.
BT - BMJ (Clinical research ed.)
C5 - General Literature
CY - England
DO - 10.1136/bmj.d6612
JF - BMJ (Clinical research ed.)
N2 - 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.
PP - England
PY - 2011
SN - 1756-1833; 0959-535X
T1 - Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial
T2 - BMJ (Clinical research ed.)
TI - Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial
U1 - General Literature
U2 - 22074851
U3 - 10.1136/bmj.d6612
VL - 343
VO - 1756-1833; 0959-535X
Y1 - 2011
ER -