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New research published in the BMJ shows how patients with mental and physical multimorbidity can benefit from integrated models of collaborative care delivered by practice nurses and psychological well-being practitioners in primary care.

Can collaborative care alleviate depression and anxiety in patients suffering from multimorbidities

Although NICE guidelines suggest that collaborative care may be useful for patients with depression and long-term conditions, there was no definitive test of effectiveness in UK primary care. The COINCIDE trial found that patients with moderate to severe depression and multiple long term conditions had lower depression and anxiety when managed within a collaborative framework that included low intensity psychological interventions and joint sessions with practice nurses.  They also reported being better self-managers and felt their care was more patient centred – key goals of therapeutic approaches based on the chronic care model.

The COINCIDE trial was led by SPCR researcher Dr Peter Coventry and included others SPCR member, including Profs Peter Bower and Karina Lovell, Dr Waquas Waheed, Dr David Reeves and Dr Mark Hann, as well as Prof Carolyn Chew-Graham (now at Keele).

A core function of SPCR funding is to conduct pilot work prior to larger funding bids. The COINCIDE trial stems from earlier SPCR funded work within the Multimorbidity theme at the University of Manchester that reviewed the effectiveness of psychological approaches to managing depression in people with diabetes: 'Identifying psychosocial interventions that improve both physical and mental health in patients with diabetes: a systematic review and meta-analysis'. The next publication, 'What is the relationship between diabetes and depression? a qualitative meta-synthesis of patient experience of co-morbidity' explored patient experiences of diabetes and depression . The COINCIDE trial was also the first trial to measure illness perceptions among people with multimorbidity using the MULTIPleS scale that was developed as part of a wider SPCR programme to better understand illness experience among people with physical and mental multimorbidity and 'Development of a multimorbidity illness perceptions scale (MULTIPleS)' was published in December 2013.

Following on from this work, the COINCIDE trial was eventually funded by the NIHR CLAHRC for Greater Manchester. 

The SPCR PREMIUM project showed that data on the impact of multimorbidity is underused in trials in the following publication: 'Self-management interventions in patients with long-term conditions: a structured review of approaches to reporting inclusion, assessment, and outcomes in multimorbidity'. Current SPCR work led by Peter Coventry will further identify what drives treatment effects associated with collaborative care in patients with depression and long term conditions.

Building on methods developed during the SPCR-funded TARDIS project,' Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data', the Manchester team will use individual patient data meta-analysis to test the relationship between patient characteristics and treatment effects for collaborative care, thus offering opportunities to better understand how to tailor collaborative care to meet the needs of patients with depression and long term conditions. 

Using our existing Cochrane review (Collaborative care for depression and anxiety problems), we have already secured access to 27 trial datasets from around the world including data on 11519 patients.” 
- Dr Peter Coventry

COINCIDE reference:

Coventry P, Lovell K, Dickens C, Bower P, Chew-Graham C, McElvenny D, Hann M, Cherrington A, Garrett C, Gibbons CJ, Baguley C, Roughley K, Adeyemi I, Reeves D, Waheed W, Gask L.Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ. 2015 Feb 16;350:h638. doi: 10.1136/bmj.h638.

 

Dr Coventry has also written a blog on the NIHR CLAHRC Greater Manchester site. 'Integrating physical and mental healthcare in primary care for people with multimorbidity'