BACKGROUND: Case management by health care assistants in small primary care practices provides unclear benefit for improving @entity308 symptoms. OBJECTIVE: To determine whether case management provided by health care assistants in small primary care practices is more effective than usual care in improving @entity308 symptoms and process of care for @entity1 with @entity308 . DESIGN: Cluster randomized, controlled trial. A central automated system generated the randomization scheme, which was stratified by urban and rural practices; allocation sequence was concealed until groups were assigned. SETTING: 74 small primary care practices in Germany from April 2005 to September 2007. @entity1 : 626 @entity1 age 18 to 80 years with @entity308 . INTERVENTION: Structured telephone interview to monitor @entity308 symptoms and support for adherence to medication, with feedback to the family physician. MEASUREMENTS: @entity308 symptoms at 12 months, as measured by the @entity1 Health Questionnaire-9 (PHQ-9); secondary outcomes were @entity1 assessment of @entity102 care, adherence to medication, and quality of life. RESULTS: A total of 310 @entity1 were randomly assigned to case management and 316 to usual care. At 12 months, 249 intervention recipients and 278 control @entity1 were assessed; 555 @entity1 were included in a modified intention-to-treat-analysis (267 intervention recipients vs. 288 control @entity1 ). Compared with control @entity1 , intervention recipients had lower mean PHQ-9 values in @entity308 symptoms (-1.41 [95% CI, -2.49 to -0.33]; P = 0.014), more favorable assessments of care (3.41 vs. 3.11; P = 0.011), and increased treatment adherence (2.70 vs. 2.53; P = 0.042). Quality-of-life scores did not differ between groups. LIMITATION: @entity1 , health care assistants, family physicians, and researchers were not blinded to group assignment, and 12-month follow-up of @entity1 was incomplete. CONCLUSION: Case management provided by primary care practice-based health care assistants may reduce @entity308 symptoms and improve process of care for @entity1 with @entity308 more than usual care. PRIMARY FUNDING SOURCE: German Ministry of Education and Research.

Case management for XXXX by health care assistants in small primary care practices: a cluster randomized trial.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PATIENTS', 'Patient'] @entity308 :: ('MESH:D003866', 'Disease') :: ['Depression', 'depression', 'major depression'] @entity102 :: ('MESH:D002908', 'Disease') :: ['chronic illness']
@entity308 :: (MESH:D003866,Disease) :: ['depression']
