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

Abstract

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

Relationships between obesity management and depression management in a university-based family medicine center

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Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

“…(continued) applied educational meetings supported by diverse additional methods such as reminders,29,48 networking 33 or distribution55 ; or performed the educational component in the form of an outreach visit, extended by distribution 24 or audit.…”

There are no randomized controlled trials that support the United States Preventive Services Task Force guideline on screening for depression in primary care: a systematic review

“…The database search identified 347 unique citations, of which 342 were excluded after title and abstract review and five after full-text review (Figure 1 ). Of the five studies that underwent full-text review, two studies were clearly not relevant, and three RCTs [ 30 - 32 ] were similar in design to trials included in the USPSTF or Cochrane reviews and met at least one criterion (see Table 1 ). Of these three RCTs, one [ 30 ] met one, and two [ 31 , 32 ] met two of the three criteria.…”