Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project Interventions for Depression ImprovementReportar como inadecuado




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BMC Public Health

, 7:253

First Online: 20 September 2007Received: 10 July 2007Accepted: 20 September 2007DOI: 10.1186-1471-2458-7-253

Cite this article as: Aragonès, E., Caballero, A., Piñol, J.L. et al. BMC Public Health 2007 7: 253. doi:10.1186-1471-2458-7-253

Abstract

BackgroundMost depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management.

Methods-DesignDesign: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression.

Setting: 20 primary care centres in the province of Tarragona Spain

Sample: 400 patients over 18 years of age who have experienced an episode of major depression DSM-IV and who need to initiate antidepressant treatment

Intervention: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care-specialized level interface.

Measurements: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to blind trial. These interviews will be given at 0, 3, 6 and 12 months.

Main variables: Severity of the depressive symptoms, response rate and remission rate.

Analysis: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster.

DiscussionThe effectiveness of caring for depression in primary care can be improved by various strategies. The most effective models involve organisational changes and a greater role of nurses. However, these models are almost exclusively from the USA, and this randomized clinical trial will determine if this approach could be effective to improve the outcomes of depression in primary care in the Spanish health care system.

Trial registrationISRCTN16384353

AbbreviationsDeffDesign effect

DSM-IVDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition

DUSOIDuke Severity of Illness Checklist

ICCIntraclass coefficient correlation

IDIAPPrimary Care Research Institute in Catalan: Institut D-Investigació en Atenció Primària

NICENational Institute for Health and Clinical Excellence

PHQ-9Patient Health Questionnaire

PRIME-MDPrimary Care Evaluation of Mental Disorders

SF-12Medical Outcomes Study Health Survey, Short-Form, 12 items

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-7-253 contains supplementary material, which is available to authorized users.

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Autor: Enric Aragonès - Antonia Caballero - Josep Ll Piñol - Germán López-Cortacans - Waleska Badia - Josep M Hernández - Pi

Fuente: https://link.springer.com/







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