***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Return to work ( RTW ) of employees on sick leave for common mental disorders may require a multidisciplinary approach . This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician ( OP ) for employees on sick leave for common mental disorders in the occupational health ( OH ) setting , compared to care as usual ( CAU ) . Methods Cluster r and omized clinical trial evaluating patients of 12 OPs receiving consultation by a psychiatrist , compared to CAU delivered by 12 OPs in the control group . 60 patients suffering from common mental disorders and ≥ six weeks sicklisted were included . Follow up three and six months after inclusion . Primary outcome measure was time to RTW . Intention- to-treat multilevel analysis and a survival analysis were performed to evaluate time to RTW in both groups . Results In CAU , referral was the main intervention . Both groups improved in terms of symptom severity and quality of life , but time to RTW was significantly shorter in the psychiatric consultation group . At three months follow up , 58 % of the psychiatric consultation group had full RTW versus 44 % of the control group , a significant finding ( P = 0.0093 ) . Survival analysis showed 68 days earlier RTW after intervention in the psychiatric consultation group ( P = 0.078 ) compared to CAU . Conclusion Psychiatric consultation for employees on sick leave in the OH setting improves time to RTW in patients with common mental disorders as compared to CAU . In further research , focus should be on early intervention in patients with common mental disorders on short sick leave duration  . Psychiatric consultation might be particularly promising for improvement of RTW in those patients . Trial registration number IS RCT N : OBJECTIVE This article describes the rationale , design , and baseline findings from an ongoing study of collaborative care for chronic musculoskeletal pain and comorbid depression . DESIGN Cluster r and omized clinical trial . PARTICIPANTS AND SETTING Forty-two clinicians and 401 patients from five Veterans Affairs primary care clinics . INTERVENTION The intervention was based on the chronic care model , and included patient and provider activation and education , patient assessment , outcomes monitoring , and feedback to providers over 12 months . The intervention team consisted of a full-time psychologist care manager and a part-time physician internist . Approaches included goal setting emphasizing function , patient activation and educating about fear avoidance , and care management . OUTCOME MEASURES Main outcomes are Rol and -Morris Disability Question naire ( RMDQ ) score , depression severity ( Patient Health Question naire-9 ) , and pain severity ( Chronic Pain Grade Severity subscale ) at 6 and 12 months . BASELINE RESULTS Fifteen percent of primary care patients mailed a study advertisement letter requested screening for the study . The mean age of enrolled patients was 62 . Back and neck or joint pain diagnoses were present in 67 % and 65 % of patients , respectively . Mean pain duration was 15 years , and mean RMDQ score ( range 0 - 24 ) was 14.7 ( st and ard deviation = 4.4 ) . Sixty-five percent of patients were receiving disability . Eighteen percent of patients met criteria for major depression , 17 % for posttraumatic stress disorder , and 9 % for alcohol misuse . Thirty-nine percent of patients felt strongly that experiencing pain was a sign of damage , and 60 % reported strong avoidance of painful activities . CONCLUSIONS These baseline data support the rationale to develop a multifaceted approach to treat chronic pain in primary care that includes detection and treatment of psychiatric comorbidity Background Care management programmes are an effective approach to care for high risk patients with complex care needs result ing from multiple co-occurring medical and non-medical conditions . These patients are likely to be hospitalized for a potentially " avoidable " cause . Nurse-led care management programmes for high risk elderly patients showed promising results . Care management programmes based on health care assistants ( HCAs ) targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need . Methods / Design PraCMan is a cluster r and omized controlled trial with primary care practice s as unit of r and omisation . The study evaluates a complex primary care practice -based care management of patients at high risk for future hospitalizations . Eligible patients either suffer from type 2 diabetes mellitus , chronic obstructive pulmonary disease , chronic heart failure or any combination . Patients with a high likelihood of hospitalization within the following 12 months ( based on insurance data ) will be included in the trial . During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and re sources as well as regular structured monitoring of symptoms . Assessment and monitoring will be performed by trained HCAs from the participating practice s. Additionally , patients will receive written information , symptom diaries , action plans and a medication plan to improve self-management capabilities . This intervention is addition to usual care . Patients from the  control group  receive usual care . Primary outcome is the number of all-cause hospitalizations at 12 months follow-up , assessed by insurance cl aims data . Secondary outcomes are health-related quality of life ( SF12 , EQ5D ) , quality of chronic illness care ( PACIC ) , health care utilisation and costs , medication adherence ( MARS ) , depression status and severity ( PHQ-9 ) , self-management capabilities and clinical parameters . Data collection will be performed at baseline , 12 and 24 months ( 12 months post-intervention ) . Discussion Practice -based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care dem and s . Trial registration Current Controlled Trials IS RCT Background Depression accounts for the greatest burden of disease among all mental health problems , and is expected to become the second-highest amongst all general health problems by 2020 . By the age of 75 , 1 in 7 older people meet formal diagnostic criteria for depression . Efforts to ameliorate the burden of illness and personal suffering associated with depression in older people have focussed on those with more severe depressive syndromes . Less attention has been paid to those with mild disorders/sub-threshold depressive syndromes but these patients also suffer impairments in their quality of life and level of functioning . Methods / Design The CASPER study has been design ed to assemble an epidemiological cohort of people over 75 years of age ( the CASPER cohort ) , from which we will identify those eligible to participate in a trial of collaborative care for sub-threshold depression ( the CASPER trial).We aim to undertake a pragmatic r and omised controlled multi-centre trial evaluating the effectiveness and cost-effectiveness of collaborative care ; a low intensity psychological intervention in addition to usual general practitioner care versus usual general practitioner care alone .  General practitioners from practice s based in the North of Engl and will be asked to identify potentially eligible patients over the age of 75 years . Patients will be sent a letter inviting them to participate in the study .We aim to recruit approximately 540 participants for the CASPER trial . A diagnostic interview will be carried out to ascertain trial eligibility with the major depressive episode module of the Mini International Neuropsychiatric Interview ( M.I.N.I. ) , eligible participants r and omised to either the intervention or usual care . The primary outcome will be measured with the Patient Health Question naire-9 ( PHQ-9 ) and additional quality of life measures will be collected . Data will be collected at baseline , 4 and 12 months for both trial and cohort participants .Trial Registration IS RCT N : IS RCT Background Primary care is the principle setting for depression treatment ; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended st and ard of care . Older African Americans are at high risk for depression due to elevated rates of chronic illness , disability and socioeconomic distress . There is an urgent need to develop and test new depression treatments that resonate with minority population s that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness . Methods / Design Beat the Blues ( BTB ) is a single-blind parallel r and omized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55 + years old . It involves a collaboration with a senior center whose care management staff screen for depressive symptoms ( telephone or in-person ) using the Patient Health Question naire ( PHQ-9 ) . Individuals screened positive ( PHQ-9 ≥ 5 ) on two separate occasions over 2 weeks are referred to local mental health re sources and BTB . Interested and eligible participants who consent receive a baseline home interview and then are r and omly assigned to receive BTB immediately or 4 months later ( wait-list control ) . All participants are interviewed at 4 ( main study endpoint ) and 8 months at home by assessors masked to study assignment . Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs , make referrals/linkages , provide depression education , instruct in stress reduction techniques , and use behavioral activation to identify goals and steps to achieve them . Key outcomes include reduced depressive symptoms ( primary ) , reduced anxiety and functional disability , improved quality of life , and enhanced depression knowledge and behavioral activation ( secondary ) . Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions . Cost and cost effectiveness is being evaluated . Discussion BTB is design ed to bridge gaps in mental health service access and treatments for older African Americans . Treatment components are tailored to specific care needs , depression knowledge , preference for stress reduction techniques , and personal activity goals . Total costs are $ 584.64/4 months ; or $ 146.16 per participant/per month . Trial Registration Clinical Trials.gov # Background Patients with depression use more health services than patients without depression . However , when depression symptoms respond to treatment , use of health services declines . Most depression quality improvement studies increase total cost in the short run , which if unevenly distributed across stakeholders , could compromise buy-in and sustainability . The objective of this budget impact analysis was to examine patterns of utilization and cost associated with telemedicine-based collaborative care , an intervention that targets patients treated in small rural primary care clinics . Methods Patients with depression were recruited from VA Community-based Outpatient Clinics , and 395 patients were enrolled and r and omized to telemedicine-based collaborative care or usual care . Dependent variables representing utilization and cost were collected from administrative data . Independent variables representing clinical casemix were collected from self-report at baseline . Results There were no significant group differences in the total number or cost of primary care encounters . However , as intended , patients in the intervention group had significantly greater depression-related primary care encounters ( marginal effect=0.34 , P=0.004 ) and cost ( marginal effect=$61.4 , P=0.013 ) to adjust antidepressant therapy for nonresponders . There were no significant group differences in total mental health encounters or cost . However , as intended , the intervention group had significantly higher depression-related mental health costs ( marginal effect=$107.55 , P=0.03 ) due to referrals of treatment-resistant patients . Unexpectedly , patients in the intervention group had significantly greater specialty physical health encounters ( marginal effect = 0.42 , P=0.001 ) and cost ( marginal effect = $ 490.6 , P=0.003 ) , but not depression-related encounters or cost . Overall , intervention patients had a significantly greater total outpatient cost compared with usual care ( marginal effect=$599.28 , P=0.012 ) . Conclusions Results suggest that telemedicine-based collaborative care does not increase total workload for primary care or mental health providers . Thus , there is no disincentive for mental health providers to offer telemedicine-based collaborative care or for primary care providers to refer patients to telemedicine-based collaborative care Objective : To describe the design of the Primary Care Research in Substance Abuse and Mental Health for Elderly ( PRISM-E ) study and baseline characteristics of the r and omized primary care patients with mental health problems and at-risk alcohol use . Method : Adults aged 65 and older were screened at primary care clinics from 10 study sites throughout the United States . Those diagnosed for depression , anxiety , and /or at-risk alcohol consumption were r and omized to either integrated or enhanced referral care . Results : Of the 23,828 participants , 14 % had a positive assessment for depressive and /or anxiety disorders  , and 6 % had at-risk alcohol consumption diagnoses . Among patients with mental health diagnoses , there was a higher preponderance of younger ages , women , and ethnic minorities . Among patients with at-risk drinking , there was a higher preponderance of younger ages , Whites , and men . Discussion : These findings indicate the need for screening in primary care and for engaging older adults in treatment Abstract Objective To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement re sources . Design Cluster r and omised controlled trial . Setting Five healthcare organisations in the United States and 60 affiliated practice s. Patients 405 patients , aged ≥ 18 years , starting or changing treatment for depression .  Intervention Care provided by clinicians , with staff providing telephone support under supervision from a psychiatrist . Main outcome measures Severity of depression at three and six months ( Hopkins symptom checklist-20 ) : response to treatment ( ≥ 50 % decrease in scores ) and remission ( score of < 0.5 ) . Results At six months , 60 % ( 106 of 177 ) of patients in intervention practice s had responded to treatment compared with 47 % ( 68 of 146 ) of patients in usual care practice s ( 
    Output:
    
Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care , and represents a useful addition to clinical pathways for adult patients with depression and anxiety