The effectiveness of a primary care based collaborative care model to improve quality of life in people with severe mental illness: the PARTNERS2 cluster randomised controlled trial

Abstract

Background Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative Care combines clinical and organisational components. Aim We tested whether a primary care-based Collaborative Care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses compared to usual care. Methods A general practice-based cluster randomised controlled superiority trial (ISRCTN 95702682). Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person centred coaching support and liaison work. The primary outcome was change in Manchester Short Assessment of Quality of Life (MANSA). Results We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices; 116 participants) or control (19 practices; 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (0.25 (s.d. 0.73) for intervention vs 0.21 (s.d. 0.86) for control); estimated fully adjusted between group difference 0.03, 95% CI -0.25 to 0.31; p=0.819. Acute mental health episodes (safety outcome) included three crises among those receiving the intervention and four among those not. Conclusion There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomes