Open Access Study protocol

Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease

Peter A Coventry1*, Karina Lovell2, Chris Dickens3, Peter Bower1, Carolyn Chew-Graham1, Andrea Cherrington1, Charlotte Garrett1, Chris J Gibbons1, Clare Baguley4, Kate Roughley1, Isabel Adeyemi1, Chris Keyworth1, Waquas Waheed5, Mark Hann1, Linda Davies1, Farheen Jeeva1, Chris Roberts1, Sarah Knowles1 and Linda Gask1

Author Affiliations

1 Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

2 School of Nursing, Midwifery & Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

3 Peninsula College of Medicine and Dentistry, University of Exeter and Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), Exeter, Devon, UK

4 IAPT North West Programme Field Lead, NHS North West, UK

5 Lancashire Care NHS Foundation Trust, Preston, UK

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Trials 2012, 13:139  doi:10.1186/1745-6215-13-139

Published: 20 August 2012

Abstract

Background

Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices.

Methods

This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial.

Discussion

COINCIDE will assess whether collaborative care can improve patient-centered outcomes, and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease. Additionally, by working with usual care providers such as IAPT, and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS, the COINCIDE trial offers opportunities to address translational gaps between research and implementation.

Trial Registration Number

ISRCTN80309252

Trial Status

Open

Keywords:
Depression; Diabetes; Coronary heart disease; Primary care; Collaborative care