Collaborative care is a way of managing care and treatment for patients with chronic conditions. Each patient is allocated a case manager (typically a mental health worker or nurse), usually based at their GP surgery, who liaises between different professionals, ensures patients adhere to treatment plans, monitors progress and delivers brief psychological therapies. Other types of support, including depression education and medicines management, may also be offered.
To date, collaborative care has been most widely adopted in the US, where it has been shown to be effective in managing mental health care. In the UK, NICE recommends collaborative care for mild to moderate depression, but only where the patient also has a chronic physical health condition and difficulty undertaking daily tasks as a result.
A review of all recent research found that patients with depression and anxiety who received collaborative care demonstrated a significantly greater improvement in their symptoms than those receiving usual care, both in the short and longer term, although the difference disappeared after two years. Patients were also more satisfied with collaborative care than usual care. This suggests collaborative care could have potential as an option for managing the care of people with depression in the UK.
These findings were echoed by a randomised controlled trial which compared collaborative care to usual care for people with depression. Some patients were offered a collaborative care package which consisted of regular phone contact with a care manager to negotiate a treatment programme, assist with medications, provide advice and support, and offer behavioural activation (a simple psychosocial therapy). This lasted around three months and consisted of up to 12 contacts. Others received usual care from their GP. After four months, the patients receiving collaborative care had a slightly lower depression score and expressed higher satisfaction with their treatment than those receiving usual care. The benefits lasted for 12 months.
Patients in both groups experienced a reduction in levels of depression, but those receiving collaborative care were more likely to respond to treatment or recover. However, the difference in depression symptoms between the two groups was quite small: 1.3 points on a 27 point scale, where the difference between moderate and moderately severe depression is considered to be five points. Whilst not a large difference, this is a similar effect to other treatments for depression, and patients were positive about the experience of receiving collaborative care.
This study also considered whether collaborative care would be cost-effective if it were adopted in UK primary care – an analysis which hadn’t been done before. From this analysis it appears likely that the gain in healthy life years would come at a reasonable cost compared to other interventions – the measure normally used by NICE. In addition, when the costs of informal care by friends or family were taken into account, collaborative care appeared likely to be cost-saving compared to usual care.
“What we learned from our research is that if you look after patients in a structured way, keep in contact with them and give them some basic mental health advice, you can achieve good results.” Professor David Richards, University of Exeter.