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ISRCTN
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ISRCTN46437760
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ClinicalTrials.gov identifier
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Public title
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Does liaison psychiatry improve the cost-effectiveness of health care delivery to depressed elderly medical in-patients? A randomised controlled trial and cost-effectiveness analysis
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Scientific title
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Acronym
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N/A
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Serial number at source
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Cullum HSR/0301
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Study hypothesis
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Aims of the study:
1. To evaluate the effect of a 'liaison' model of care (screening, plus assessment and co-ordination of management of depressive disorder by a specialist psychiatric nurse) on the health outcomes of elderly medical inpatients.
2. To evaluate the cost-effectiveness of the intervention from the viewpoint of health and social services, and patients and their carers.
Hypotheses: Compared to standard care, after 16 weeks, the 'liaison' model of care will:
1. Increase the number of patients that recover from depression
2. Increase patients' quality of life
3. Increase patients' satisfaction with the service
4. Reduce carer burden
5. Increase the cost-effectiveness ratios for the health benefits (resolution of depression, change in depression rating and quality of life score per cost of resources used).
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Lay summary
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Ethics approval
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Not provided at time of registration
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Study design
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Randomised controlled trial
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Countries of recruitment
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United Kingdom
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Disease/condition/study domain
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Depression, anxiety, neuroses
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Participants - inclusion criteria
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Patients aged 65 years or over, admitted to general medical wards of a district general hospital (West Suffolk Hospital) with a stay over 5 days, over a period of 15 months (January 2002 to March 2003).
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Participants - exclusion criteria
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1. Unable to give informed consent to enter the study due to moderate/severe dementia or other reasons
2. No spoken English
3. Dependent upon alcohol or other psychotropic drugs
4. Due to be transferred or discharged on the day of the initial assessment
5. Too physically ill or too confused to be interviewed
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Anticipated start date
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01/01/2002
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Anticipated end date
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01/01/2004
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Status of trial
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Completed |
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Patient information material
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Target number of participants
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138 (added 18/12/09)
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Interventions
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1. A visit by a specialist nurse within the first week of admission (intervention arm)
2. Put on a waiting list to see a member of the research team at home (control arm)
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Primary outcome measure(s)
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Resolution of ICD10 depression and change in depression rating measured by the Montgomery-Asberg Depression Rating Scale (MADRS) at 16 weeks after the initial assessment compared between intervention and comparison groups, adjusted for severity of disability at baseline.
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Secondary outcome measure(s)
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Change in quality of life score (EuroQOL), difference in patient satisfaction (adapted version of patients' satisfaction with stroke services questionnaire), change in carer burden (Caregiver Strain Index and GHQ-12) at 16 weeks after the initial assessment, compared between intervention and comparison groups. (References for standardised measures given in attached research proposal.) Cost-effectiveness ratios for the health benefits resolution of depression, change in depression and quality of life scores) compared to the resource costs in each arm of the study will be calculated. Resources consumed in secondary care (costs of index admission, subsequent inpatient stay and outpatient contact), primary care (GP consultations, contact with nursing staff including specialist psychiatric nurse), and number of hours care from social services will be calculated from routine data sources including hospital information systems, GP and medical records and social services information systems. The economic impact of the intervention upon patients and their carers will also be evaluated.
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Sources of funding
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NHS Executive Eastern (UK)
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Trial website
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Publications
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2007 results in http://www.ncbi.nlm.nih.gov/pubmed/17537739
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Contact name
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Dr
Sarah
Cullum
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Address
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University of Cambridge
Institute of Public Health
Forvie Site
Robinson Way
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City/town
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Cambridge
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Zip/Postcode
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CB2 2SR
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Country
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United Kingdom
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Tel
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+44 (0)1223 330322
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Fax
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+44 (0)1223 762515
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Email
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Sponsor
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NHS R&D Regional Programme Register - Department of Health (UK)
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Address
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The Department of Health
Richmond House
79 Whitehall
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City/town
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London
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Zip/Postcode
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SW1A 2NL
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Country
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United Kingdom
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Tel
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+44 (0)20 7307 2622
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Fax
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+44 (0)20 7307 2623
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Email
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dhmail@doh.gsi.org.uk
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Sponsor website:
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http://www.doh.gov.uk
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Date applied
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23/01/2004
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Last edited
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21/12/2009
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Date ISRCTN assigned
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23/01/2004
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