Outcomes of a randomized trial for multimorbidity - the TrueBlue study

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Outcomes of a randomized trial for multimorbidity - the TrueBlue study Morgan MAJ, Coates MJ, Dunbar JA, et al. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial. BMJ Open 2013;3 Research Question: How effective is collaborative care in depressed patients with diabetes or heart disease or both? Why this is important? Multimorbidity is the norm in patients with diabetes and complicates care. There is a need for timetabled, protocol driven care, with tasks shared between the team, a robust communication tool and a case-manager to coordinate. This is collaborative care. BP34 Adherence to Antibiotic Prescribing for LRTI and Association With Recovery (Oral Presentation On Completed Research) Nick Francis, MD, PhD, Cardiff University; David Gillespie; Jacqueline Nuttall; Paul Little; Theo Verheij; Samuel Coenen; Jochen Cals; Kerenza Hood; Herman Goossens; Christopher Butler

What the researchers did A two-arm open randomised cluster controlled trial with usual care as control. Subjects: Australian primary care patients with diabetes &/or Coronary Heart Disease + Depression (n=400) Intervention: Each 3 months Practice nurse (45 minutes): Physical measures, pathology results, PHQ9 (depression) responses and lifestyle. Goal setting and problem solving to develop or review up to three personal goals Case-management referrals and recall date Patient-held care plan Primary care physician (15 minutes) for clinical decisions aged ≥18 years, consulting with an illness where an acute or worsened cough was the main or dominant symptom, or had a clinical presentation that suggested a lower respiratory tract infection that had been present for ≥28 days.

What the researchers found Depression reduced (10.7 to 7.1 on PHQ9) Cardiovascular risk reduced (27.4% to 24.8%) Exercising increased (41% to 60% of patients) Goal setting (81%achieved,14% re-negotiated) Adherence to best-practice guidelines for diabetes, heart disease and depression

What this means for clinical practice Successful ingredients for collaborative care in multimorbidity: Combined guideline based on patient priorities Patient-held summary and plan Nurses skilled in goal setting, problem solving and depression assessment