The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial

Morgan, Mark A.J., Coates, Michael J., Dunbar, James A., Reddy, Prasuna, Schlicht, Kate and Fuller, Jeff 2013, The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial, BMJ Open, vol. 3, Article e002171, pp. 1-11.

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Title The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial
Author(s) Morgan, Mark A.J.
Coates, Michael J.
Dunbar, James A.
Reddy, Prasuna
Schlicht, Kate
Fuller, Jeff
Journal name BMJ Open
Volume number 3
Season Article e002171
Start page 1
End page 11
Total pages 11
Publisher BMJ Group
Place of publication London, England
Publication date 2013
ISSN 2044-6055
Keyword(s) depression risk factors
depression and chronic disease
self-care
Summary Objectives:
To determine the effectiveness of 
collaborative care in reducing depression in primary care patients with diabetes or heart disease using practice nurses as case managers.
Design:
A two-arm open randomised cluster trial with wait-list control for 6 months. The intervention was followed over 12 months.
Setting:
Eleven Australian general practices, five randomly allocated to the intervention and six to the control.
Participants:
400 primary care patients (206 intervention, 194 control) with depression and type 2 diabetes, coronary heart disease or both.
Intervention:
The practice nurse acted as a case manager identifying depression, reviewing pathology results, lifestyle risk factors and patient goals and priorities. Usual care continued in the controls.
Main outcome measure:
A five-point reduction in depression scores for patients with moderate-to-severe depression. Secondary outcome was improvements in physiological measures.
Results:
Mean depression scores after 6 months of intervention for patients with moderate-to-severe depression decreased by 5.7±1.3 compared with 4.3±1.2 in control, a significant (p=0.012) difference. (The plus–minus is the 95% confidence range) Intervention practices demonstrated adherence to treatment guidelines and intensification of treatment for depression, where exercise increased by 19%, referrals to exercise programmes by 16%, referrals to mental health workers (MHWs) by 7% and visits to MHWs by 17%. Control-practice exercise did not change, whereas referrals to exercise programmes dropped by 5% and visits to MHWs by 3%. Only referrals to MHW increased by 12%. Intervention improvements were sustained over 12 months, with a significant (p=0.015) decrease in 10-year cardiovascular disease risk from 27.4±3.4% to 24.8±3.8%. A review of patients indicated that the study’s safety protocols were followed.
Conclusions:
TrueBlue participants showed significantly improved depression and treatment intensification, sustained over 12 months of intervention and reduced 10-year cardiovascular disease risk. Collaborative care using practice nurses appears to be an effective primary care intervention.
Language eng
Field of Research 111717 Primary Health Care
Socio Economic Objective 920104 Diabetes
HERDC Research category C1 Refereed article in a scholarly journal
HERDC collection year 2013
Persistent URL http://hdl.handle.net/10536/DRO/DU:30056003

Document type: Journal Article
Collections: Population Health
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Created: Fri, 13 Sep 2013, 13:17:54 EST by Barb Lavelle

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