Clinical effectiveness of care managers in collaborative primary health care for patients with depression : 12‑ and 24‑month follow‑up of a pragmatic cluster randomized controlled trial

Background: In previous studies, we investigated the effects of a care manager intervention for patients withdepression treated in primary health care. At 6 months, care management improved depressive symptoms, remission,return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study wasto compare the long-term effectiveness of care management and usual care for primary care patients with depressionon depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and24 months after the start of the intervention.Methods: Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control)in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderatedepression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed astructured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care managerfollowed up symptoms and treatment, encouraged behavioral activation, provided education, and communicatedwith the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixedmodel repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptomsand remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specificquestionnaire).Results: The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) butnot 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differencesin remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from theprimary care center.Conclusions: Patients with depression who had a care manager maintained their 6-month improvements in symptomsat the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients withcare managers also had significantly more confidence in primary care and belief in future support than controls