In other areas of mental healthcare, organisational interventions developed in the US have not generalised outside the original healthcare context.8 For collaborative care, there is some supportive evidence from other contexts, including the developing world,9 10 but uncertainty around the standardised effect size in trials in the United Kingdom (standardised mean difference 0.24, 95% confidence interval 0.060 to 0.547) and elsewhere.7 Owing to these limited non US data and the relatively small effect size in trials of patients with depression alone pandora essence, the UK National Institute for Health and Care Excellence (formerly the National Institute for Health and Clinical Excellence)11 issued a research recommendation for a fully powered UK evaluation of collaborative care.There is considerable variation between study heterogeneity in terms of the duration and intensity of collaborative care, and in the training and background of care managers used in the reported studies. Therefore, we carefully developed our collaborative care intervention to apply outside the US, in healthcare systems with a well developed primary care sector.12 13 14 In our development work,12 we designed a care management intervention after systematic review,7 15 in depth qualitative interviews with patients, general practitioners, and mental health workers, and through consultations with the intervention originators in the US. In our phase II testing of this intervention,13 we found preliminary evidence indicating that collaborative care adapted to the UK was acceptable to patients and doctors, and could be effective outside the US, but that a cluster randomised controlled trial was needed to guard against potential contamination between trial arms.13 Consequently, we undertook a pragmatic cluster randomised trial to determine whether collaborative care is more clinically effective than usual care in the management of patients with moderate to severe depression.MethodsStudy designThe Clinical and Cost Effectiveness of Collaborative Care for Depression in UK Primary Care Trial (CADET) was a multicentre, two group, cluster randomised controlled trial.Setting and participantsWe recruited participants between June 2009 and January 2011 from the electronic case records of primary care general practices in three UK sites: Bristol, London, and greater Manchester.
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