Does referral to psychiatry improve outcome in patients with refractory depression?
(After Katon et al, 1999) This study aimed to determine whether referral to a psychiatrist working in close collaboration with a GP would improve outcomes for patients who had been started on an antidepressant but had not made a satisfactory recovery. Patients (aged 18 80) of several health centres were contacted. They had been prescribed antidepressants for depression or anxiety. Those who still had significant symptoms at 6 8 weeks after the prescription were invited to participate and randomised to either usual care or stepped collaborative care . Usual care meant that their GP continued to manage their symptoms. Stepped collaborative care involved a complex intervention delivered by a psychiatrist based in primary care reviewing the patients, giving them information on the treatment of depression and monitoring progress closely. Follow-up was performed by telephone interviewers who were blind to the randomisation status of the patients. The main outcomes assessed included process o
