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

Mark A J Morgan, Michael J. Coates, James A. Dunbar, Prasuna Reddy, Kate Schlicht, Jeff Fuller

Research output: Contribution to journalArticleResearchpeer-review

43 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere002171
JournalBMJ Open
Volume3
Issue number1
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Heart Diseases
Nurses
Depression
Mental Health
Referral and Consultation
Exercise
Primary Health Care
Cardiovascular Diseases
Case Managers
General Practice
Type 2 Diabetes Mellitus
Coronary Disease
Life Style
Therapeutics
Outcome Assessment (Health Care)
Guidelines
Pathology
Safety

Cite this

Morgan, Mark A J ; Coates, Michael J. ; Dunbar, James A. ; Reddy, Prasuna ; Schlicht, Kate ; Fuller, Jeff. / The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease : A randomised trial. In: BMJ Open. 2013 ; Vol. 3, No. 1.
@article{88866e916a254dc0a26cdf661b40d280,
title = "The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: A randomised trial",
abstract = "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.",
author = "Morgan, {Mark A J} and Coates, {Michael J.} and Dunbar, {James A.} and Prasuna Reddy and Kate Schlicht and Jeff Fuller",
year = "2013",
doi = "10.1136/bmjopen-2012-002171",
language = "English",
volume = "3",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "1",

}

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; Fuller, Jeff.

In: BMJ Open, Vol. 3, No. 1, e002171, 2013.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease

T2 - A randomised trial

AU - Morgan, Mark A J

AU - Coates, Michael J.

AU - Dunbar, James A.

AU - Reddy, Prasuna

AU - Schlicht, Kate

AU - Fuller, Jeff

PY - 2013

Y1 - 2013

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84873473869&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2012-002171

DO - 10.1136/bmjopen-2012-002171

M3 - Article

VL - 3

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - e002171

ER -