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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2012; 12: 58.
Published online Jun 6, 2012. doi:  10.1186/1471-244X-12-58
PMCID: PMC3437191
A pilot randomised controlled trial of personalised care for depressed patients with symptomatic coronary heart disease in South London general practices: the UPBEAT-UK RCT protocol and recruitment
André Tylee,corresponding author1 Mark Haddad,1 Elizabeth Barley,1 Mark Ashworth,2 June Brown,3 John Chambers,4 Anne Farmer,5 Zoe Fortune,1 Rebecca Lawton,1 Morven Leese,1 Anthony Mann,1 Paul McCrone,1 Joanna Murray,1 Carmine Pariante,6 Rachel Phillips,1 Diana Rose,1 Gill Rowlands,7 Ramon Sabes-Figuera,1 Alison Smith,1 and Paul Walters1
1Health Services and Population Research Dept, Institute of Psychiatry at King’s College London, De Crespigny Park, London, SE5 8AF, UK
2Department of Primary Care and Public Health Sciences, King’s College London, 9th Floor, Capital House, 42 Weston Street, London, SE1 3QD, UK
3Department of Psychology, Institute of Psychiatry at King’s College London, De Crespigny Park, London, SE5 8AF, UK
4Department of Cardiology, Guy’s and St Thomas’ Hospitals, Westminster Bridge Road, London, SE17EH, UK
5Department of Social Genetic and Developmental Psychiatry, Institute of Psychiatry at King’s College London, De Crespigny Park, London, SE5 8AF, UK
6Department of Psychological Medicine, Institute of Psychiatry at King’s College London, De Crespigny Park, London, SE5 8AF, UK
7Faculty of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
corresponding authorCorresponding author.
André Tylee: a.tylee/at/iop.kcl.ac.uk; Mark Haddad: mark.haddad/at/iop.kcl.ac.uk; Elizabeth Barley: e.barley/at/iop.kcl.ac.uk; Mark Ashworth: markashworth/at/nhs.net; June Brown: june.brown/at/kcl.ac.uk; John Chambers: jboydchambers/at/aol.com; Anne Farmer: anne.farmer/at/kcl.ac.uk; Zoe Fortune: zoe.1.fortune/at/kcl.ac.uk; Rebecca Lawton: rebecca.lawton/at/kcl.ac.uk; Morven Leese: morven.leese/at/kcl.ac.uk; Anthony Mann: anthony.mann/at/kcl.ac.uk; Paul McCrone: paul.mccrone/at/kcl.ac.uk; Joanna Murray: Joanna.Murray/at/iop.kcl.ac.uk; Carmine Pariante: carmine.pariante/at/kcl.ac.uk; Rachel Phillips: rachel.phillips/at/kcl.ac.uk; Diana Rose: diana.rose/at/kcl.ac.uk; Gill Rowlands: rowlang2/at/lsbu.ac.uk; Ramon Sabes-Figuera: ramon.sabes-figuera/at/kcl.ac.uk; Alison Smith: alison.1.smith/at/kcl.ac.uk; Paul Walters: p.walters/at/iop.kcl.ac.uk
Received December 5, 2011; Accepted June 6, 2012.
Abstract
Background
Community studies reveal people with coronary heart disease (CHD) are twice as likely to be depressed as the general population and that this co-morbidity negatively affects the course and outcome of both conditions. There is evidence for the efficacy of collaborative care and case management for depression treatment, and whilst NICE guidelines recommend these approaches only where depression has not responded to psychological, pharmacological, or combined treatments, these care approaches may be particularly relevant to the needs of people with CHD and depression in the earlier stages of stepped care in primary care settings.
Methods
This pilot randomised controlled trial will evaluate whether a simple intervention involving a personalised care plan, elements of case management and regular telephone review is a feasible and acceptable intervention that leads to better mental and physical health outcomes for these patients. The comparator group will be usual general practitioner (GP) care.
81 participants have been recruited from CHD registers of 15 South London general practices. Eligible participants have probable major depression identified by a score of ≥8 on the Hospital Anxiety and Depression Scale depression subscale (HADS-D) together with symptomatic CHD identified using the Modified Rose Angina Questionnaire.
Consenting participants are randomly allocated to usual care or the personalised care intervention which involves a comprehensive assessment of each participant’s physical and mental health needs which are documented in a care plan, followed by regular telephone reviews by the case manager over a 6-month period. At each review, the intervention participant’s mood, function and identified problems are reviewed and the case manager uses evidence based behaviour change techniques to facilitate achievement of goals specified by the patient with the aim of increasing the patient’s self efficacy to solve their problems.
Depressive symptoms measured by HADS score will be collected at baseline and 1, 6- and 12 months post randomisation. Other outcomes include CHD symptoms, quality of life, wellbeing and health service utilisation.
Discussion
This practical and patient-focused intervention is potentially an effective and accessible approach to the health and social care needs of people with depression and CHD in primary care.
Trial registration
ISRCTN21615909.
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