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BMC Health Services Research
Published in: BMC Health Services Research 1/2007

Open Access 01-12-2007 | Study protocol

Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

Authors: Eva K Horn, Tjeerd B van Benthem, Leona Hakkaart-van Roijen, Harm WJ van Marwijk, Aartjan TF Beekman, Frans F Rutten, Christina M van der Feltz-Cornelis

Published in: BMC Health Services Research | Issue 1/2007

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Abstract

Background

Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated.

Methods/Design

CC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36.

Discussion

Earlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster with physical comorbidity. Even though the treatment of depressive disorder based on the guidelines for depression is proven effective, these guidelines are often insufficiently adhered to. Collaborative care and 'Problem Solving Treatment' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherlands.
Appendix
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Metadata
Title
Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial
Authors
Eva K Horn
Tjeerd B van Benthem
Leona Hakkaart-van Roijen
Harm WJ van Marwijk
Aartjan TF Beekman
Frans F Rutten
Christina M van der Feltz-Cornelis
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2007
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-7-28

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