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Collaborative Interventions for Circulation and Depression (COINCIDE)

Please see the downloable resources section of this web page to access the COINCIDE training manuals, these can be freely donwloaded. 

 

Background

Significant gains have been made in primary care over recent years to improve access to and quality of depression care, with one promising intervention being ‘collaborative care’, a complex intervention which involves the use of a non-medical case manager – e.g. a Psychological Wellbeing Practitioner (PWP) or a nurse – working in conjunction with the patient’s doctor, often with the support and supervision of a mental health specialist (normally a psychiatrist or psychologist). Between 2008-13, NIHR CLAHRC Greater Manchester tested a collaborative care approach known as Collaborative Care for Circulation and Depression (COINCIDE) in the NHS, which involved a clinical trial across the north-west in 36 GP surgeries using trained Psychological Wellbeing Practitioners (PWPs) and practice nurses to deliver the COINCIDE intervention, based on a collaborative care model. Most collaborative care trials have previously been conducted in the United States; the Clinical Effectiveness of Collaborative Care for Depression in UK Primary Care Trial (CADET) was an important first step to showing collaborative care can work in the NHS, but it did not exclusively look at treatment of people with long term conditions or multi-morbidity. Read this research paper, published in the British Medical Journal (BMJ), to find out more about the first test of collaborative care in the NHS.

 

About the COINCIDE trial

COINCIDE was run as a ‘pragmatic’ trial in that it tested collaborative care in real world settings, using Improved Access to Psychological Therapy (IAPT) services and practice nurses. It aimed to show reductions in depression and also other patient reported outcomes such as quality of life and self-management behaviour.

 

 

Trial Process and Participent Characteristics

Once GP surgeries agreed to be in the trial they were randomised to ‘collaborative care’ or ‘usual care’; the CONSORT flow diagram below shows the flow of participants through the trial after randomisation:

 

 

CONSORT flow diagram showing the number of patients recruited and followed-up at each stage of the trial

 

Participant characteristics

The participants in the trial were from deprived areas, had relatively high levels of depression – and many LTCs, but only half were treated for their depression or anxiety.

 

  • 76% of participants were recruited from practices from moderately and heavily deprived areas;

  • Only 25% of participants were in paid employment;

  • 63% of participants met criteria for moderately severe (or severe depression);

  • 75% of participants met criteria for case-ness for anxiety;

  • Participants had a mean of 6.2 long term conditions in addition to either diabetes or coronary heart disease;

  • 62% of participants were male, with a mean age of 58.5 years (11.7);

  • Half of participants were prescribed anti-depressant or anti-anxiety medication at baseline.
     

Therefore, participants in the COINCIDE trial had high levels of psychological and physical ill health and were mainly from deprived areas.

 

Key Findings from the Trial

There were a range of key findings in the COINCIDE trail from clinical findings and process outcomes to process of care and identification of strengths and weaknesses. Click on each of the links below to find out more:

 

 

Local and national impact of the work

 

Downloadable resources

 

 

Who did we work with

Inclusion Matters

Mental Health Matters

South Stafford and Shropshire NHS Foundation Trust

 

More information

For further information about the project, please contact Michael Spence (Programme Manager).