The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester brings leading clinical experts together with world class researchers in the University of Manchester, whose “know-how” is linked with that of frontline healthcare providers and commissioners, to develop and implement innovations for people with long-term conditions (such as stroke, diabetes, kidney disease and heart disease) that promote patient self-management, improve quality of care, and make more efficient use of scarce NHS resources.
Depression is twice as common in people with long-term conditions such as diabetes and heart disease and is associated with poorer health outcomes (including increased mortality and complications) and quality of life. The National Institute for Health and Care Excellence (NICE) recommends collaborative care as a suitable treatment for patients with moderate to severe depression and a long-term health condition with associated functional impairment. Collaborative care is a structured, multi-professional approach to depression care in which patient care is coordinated by a case manager who liaises with other healthcare professionals, provides medication management, and delivers guided self-help interventions.
COINCIDE is a pragmatic randomised controlled trial which aims to test the effectiveness and cost-effectiveness of a collaborative care intervention for depression in people with depression and heart disease and/or diabetes. In the COINCIDE trial, specially trained Psychological Wellbeing Practitioners (PWPs) from NHS Improving Access to Psychological Therapy (IAPT) teams act as case managers. PWPs are already trained in the use of brief psychological guided self-help interventions. The COINCIDE training increases their knowledge of heart disease and diabetes and teaches them to adapt their existing interventions for working with people with these conditions. It also introduces them to the collaborative care model and the way they work with patients and practice staff.
Since the trial began in January 2012, we have successfully recruited 11 IAPT teams, 36 GP practices and 387 patients from across the North West of England. Staff have been trained and care delivered. Follow-up from the study and collection of data for the health economic analysis has now been completed. Initial analyses of the data are being conducted with the results of the trial being published at the end of the year. The trial will offer a rigorous assessment of whether collaborative care can improve depression in people with long-term conditions in a cost-effective way, thereby informing future policy and decision making about the delivery of effective and efficient services for this under-treated population.