Effectiveness of a multi-component programme for managing depression in primary care: A cluster randomized trial. The INDI project

Aragonès, Enric; Piñol, Josep; Caballero, Antonia; López-Cortacans, Germán; Casaus, Pilar; Hernández, Josep M; Badia, Waleska; Folch, Silvia

doi:10.1016/j.jad.2012.05.020

Cited by 46 publications

(38 citation statements)

References 33 publications

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“…In people with CHD[4], [50], even intensive treatments, such as CBT, problem solving and SSRIs have only a small effect on depression. Interprofessional working to ensure receipt of guideline informed treatment has been a key element in a number of successful trials of complex interventions for depression in primary care patients[6], [7], [51]. In this pilot study, four participants in the PC group compared with none in the TAU group received new depression treatment (antidepressant treatment or psychological treatment) by the end of the pilot study.…”

Section: Discussionmentioning

confidence: 99%

The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

et al. 2014

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BackgroundDepression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression.MethodsMulti-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables.Result1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000.ConclusionsTrial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU.Trial RegistrationControlled-Trials.com ISRCTN21615909

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Section: Discussionmentioning

confidence: 99%

The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

et al. 2014

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“…In order to improve the quality care for depression, organizational barriers to the implementation of a depression guideline, in the complex realities of PC, is a significant factor to take into account. In that sense, it should be mentioned that collaborative care in primary care has shown effectiveness in the management of depression [32,33]. However, this is a multi-component approach which requires the involvement of additional staff like nurses.…”

Section: Discussionmentioning

confidence: 99%

“…However, this is a multi-component approach which requires the involvement of additional staff like nurses. Currently, it is not a usual practice for the management of depression in Spain [33]. The aim of this study was to test the implementation of a specific recommendation regarding depression screening in the current everyday reality of the primary care setting in Spain.…”

Section: Discussionmentioning

confidence: 99%

Systematic depression screening in high-risk patients attending primary care: a pragmatic cluster-randomized trial

Romera

Montejo

Aragonès³

et al. 2013

BMC Psychiatry

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BackgroundSystematic screening for depression in high-risk patients is recommended but remains controversial. The aim of this study was to assess the effectiveness of such screening in everyday clinical practice on depression recognition.MethodsA pragmatic, cluster randomized, controlled study that randomized primary care physicians (PCPs) in Spain either to an intervention or control group. The intervention group (35-PCPs) received training in depression screening and used depression screening routinely for at least 6 months. The control group (34-PCPs) managed depression in their usual manner. Adherence to (1–6; never-very frequently), feasibility (1–4; unfeasible-very feasible), and acceptance (1–5; very poor-very good) of the screening were evaluated. Underrecognition (primary outcome) and undertreatment rates of major depressive disorder (MDD) in the two groups were compared 6 months after randomization in a random sample of 3737 patients assigned to these PCPs using logistic regression adjusting for the clustering effect.ResultsNo significant differences were found for recognition rates (58.0% vs. 48.1% intervention vs. control; OR [95%CI] 1.40 [0.73-2.68], p = 0.309). The undertreatment rate did not differ significantly either (p = 0.390). The mean adherence to depression screening was 4.4 ± 1.0 (‘occasionally’), the mean feasibility was 3.1 ± 0.5 (‘moderately feasible’), and the mean acceptance was 4.2 ± 0.6 (‘good’).ConclusionsThis research was not able to show effectiveness of the systematic screening for MDD in high-risk patients on depression recognition in primary care. The poor adherence to screening implementation could partially explain the results. These reflect the difficulties of putting into practice the clinical guidelines usually based on interventional research.Trial registrationClinicaltrials.gov NCT01662817

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“…Elderly patients showed long-term improvement in their depressive symptomatology in the IMPACT-trial [15]. A program to manage depression interprofessionally proved to be effective in the INDI-trial [16]. …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial

et al. 2014

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BackgroundAnxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system.In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the “Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care” (SMADS)-Study.Methods/DesignThe study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment.DiscussionThe SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance their expected self-efficacy, reduce their symptom load and engage in more self-help activities to deal with their everyday lives. After successfully evaluating this psychosocial intervention, a new health care model for the management of symptoms of anxiety, depression and somatoform disorders for ambulatory patients could emerge, supplementing the work of the GP.Trial registrationClinicaltrials.gov Identifier: NCT01726387

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Effectiveness of a multi-component programme for managing depression in primary care: A cluster randomized trial. The INDI project

Cited by 46 publications

References 33 publications

The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

Systematic depression screening in high-risk patients attending primary care: a pragmatic cluster-randomized trial

Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial

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