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Collaborative Care for Depression and Posttraumatic Stress Disorder: Evaluation of Collaborative Care Fidelity on Symptom Trajectories and Outcomes
- Source :
- Journal of general internal medicine. 33(7)
- Publication Year :
- 2017
-
Abstract
- BACKGROUND: Despite the growing consensus that collaborative care is effective, limited research has focused on the importance of collaborative care fidelity as it relates to mental health clinical outcomes. OBJECTIVE: To assess the relationship of collaborative care fidelity on symptom trajectories and clinical outcomes among military service members enrolled in a multi-site randomized controlled trial for the treatment of depression and posttraumatic stress disorder (PTSD). DESIGN: Study data for our analyses came from a two-parallel arm randomized trial that evaluated the effectiveness of a centralized collaborative care model compared to the existing collaborative care model for the treatment of PTSD and depression. All patients were included in the analyses to evaluate how longitudinal trajectories of PTSD and depression scores differed across various collaborative care fidelity groupings. PARTICIPANTS: A total of 666 US Military Service members screening positive for probable PTSD or depression through primary care. MAIN MEASURES: Disease registry data from a web-based clinical management support tool was used to measure collaborative care fidelity for patients enrolled in the trial. Participant depression and PTSD symptoms were collected independently from research survey assessments at four time points across the 1-year trial period. Treatment utilization records were acquired from the Military Health System administrative records to determine mental health service use. KEY RESULTS: Consistent and late fidelity to the collaborative care model predicted an improving symptom trajectory over the course of treatment. This effect was more pronounced for patients with depression than for patients with PTSD. CONCLUSIONS: Long-term fidelity to key collaborative care elements throughout care episodes may improve depression outcomes, particularly for patients with elevated symptoms. More controlled research is needed to further understand the influence of collaborative care fidelity on clinical outcomes. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT01492348
- Subjects :
- Adult
Male
medicine.medical_specialty
media_common.quotation_subject
Military service
Fidelity
Collaborative Care
law.invention
Stress Disorders, Post-Traumatic
03 medical and health sciences
0302 clinical medicine
Disease registry
Randomized controlled trial
law
Internal Medicine
medicine
Humans
030212 general & internal medicine
Psychiatry
Intersectoral Collaboration
Depression (differential diagnoses)
media_common
Original Research
Primary Health Care
business.industry
Depression
Mental health
030227 psychiatry
Posttraumatic stress
Military Personnel
Treatment Outcome
Female
business
Subjects
Details
- ISSN :
- 15251497
- Volume :
- 33
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Journal of general internal medicine
- Accession number :
- edsair.doi.dedup.....ed870619bcfd0f7ababf8460f5705d6e