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A care management intervention improved depression after stroke

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 Q In patients with depression after stroke, does a care management intervention improve depression outcomes more than usual care?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ Neurology ★★★★★★☆ Psychiatry ★★★★★☆☆ Internal medicine ★★★★★☆☆


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (outcome assessor).*

Embedded ImageFollow up period:

12 weeks.

Embedded ImageSetting:

4 hospitals in Indianapolis, Indiana, USA.

Embedded ImagePatients:

188 patients ⩾18 years of age (mean age 60 y, 54% women) who had major (74%) or minor (26%) depression after ischaemic stroke (patients were identified at the time of stroke and screened for depression 1–2 mo later), no severe language or cognitive impairment, and a life expectancy ⩾6 months. Exclusion criteria included active psychosis, suicidality, substance abuse, use of a monoamine oxidase inhibitor, and pregnancy.

Embedded ImageIntervention:

the “Activate–Initiate–Monitor” care management intervention (n = 94) or usual care (n = 94). The intervention, conducted by nurse care …

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  • * See glossary.

  • For correspondence: Dr L S Williams, Roudebush VA Medical Center, Indianapolis, IN, USA. linwilli{at}

  • Source of funding: National Institutes of Health/National Institute of Neurological Disorders and Stroke.

  • Abstract also appears in Evidence-Based Nursing.

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