BACKGROUND: There are significant shortcomings in the management and clinical outcomes of depressed patients. The objective is to assess the effectiveness of a multi-component programme to improve the management of depression in primary care. METHODS: This is a cluster-randomized controlled trial, conducted between June 2007 and June 2010. Twenty primary care centres were allocated to intervention group or usual care group. The intervention consisted of a multi-component programme with clinical, educational and organizational procedures including primary care nurses working as case-managers. Outcomes were monitored by a blinded interviewer at 0, 3, 6 and 12 months. TRIAL REGISTRATION: ISRCTN16384353, at http://isrctn.org. RESULTS: In total, 338 adult patients with major depression (DSM-IV) were assessed at baseline. At 12 months, 302 patients were assessed, 172 in the intervention group and 130 in the control group. The severity of depression (mean Patient Health Questionnaire-9 score) was 1.76 points lower in the intervention group [7.15 vs. 8.78, 95% CI=-3.53 to 0.02, p=0.053]. The treatment response rate was 15.4% higher in the intervention group than in the controls [66.9% vs. 51.5%, odds ratio 1.9, 95% CI=1.2 to 3.1, p=0.011)], and the remission rate was 13.4% higher [48.8% vs. 35.4%, odds ratio 1.8, 95% CI=1.1 to 2.9, p=0.026)]. LIMITATIONS: Unblinded physicians diagnosed depression in their patients and decided whether to include them in the study, so we cannot discount a hidden selection bias. CONCLUSIONS: The programme for managing depression leads to better clinical outcomes in patients with major depression in primary care settings.
RCT Entities:
BACKGROUND: There are significant shortcomings in the management and clinical outcomes of depressedpatients. The objective is to assess the effectiveness of a multi-component programme to improve the management of depression in primary care. METHODS: This is a cluster-randomized controlled trial, conducted between June 2007 and June 2010. Twenty primary care centres were allocated to intervention group or usual care group. The intervention consisted of a multi-component programme with clinical, educational and organizational procedures including primary care nurses working as case-managers. Outcomes were monitored by a blinded interviewer at 0, 3, 6 and 12 months. TRIAL REGISTRATION: ISRCTN16384353, at http://isrctn.org. RESULTS: In total, 338 adult patients with major depression (DSM-IV) were assessed at baseline. At 12 months, 302 patients were assessed, 172 in the intervention group and 130 in the control group. The severity of depression (mean Patient Health Questionnaire-9 score) was 1.76 points lower in the intervention group [7.15 vs. 8.78, 95% CI=-3.53 to 0.02, p=0.053]. The treatment response rate was 15.4% higher in the intervention group than in the controls [66.9% vs. 51.5%, odds ratio 1.9, 95% CI=1.2 to 3.1, p=0.011)], and the remission rate was 13.4% higher [48.8% vs. 35.4%, odds ratio 1.8, 95% CI=1.1 to 2.9, p=0.026)]. LIMITATIONS: Unblinded physicians diagnosed depression in their patients and decided whether to include them in the study, so we cannot discount a hidden selection bias. CONCLUSIONS: The programme for managing depression leads to better clinical outcomes in patients with major depression in primary care settings.
Authors: Thomas Zimmermann; Egina Puschmann; Martin Ebersbach; Anne Daubmann; Susanne Steinmann; Martin Scherer Journal: BMC Psychiatry Date: 2014-01-03 Impact factor: 3.630
Authors: Elizabeth A Barley; Paul Walters; Mark Haddad; Rachel Phillips; Evanthia Achilla; Paul McCrone; Harm Van Marwijk; Anthony Mann; Andre Tylee Journal: PLoS One Date: 2014-06-05 Impact factor: 3.240
Authors: Enric Aragonès; Diego Palao; Germán López-Cortacans; Antonia Caballero; Narcís Cardoner; Pilar Casaus; Myriam Cavero; José Antonio Monreal; Víctor Pérez-Sola; Miquel Cirera; Maite Loren; Eva Bellerino; Catarina Tomé-Pires; Laura Palacios Journal: BMC Health Serv Res Date: 2017-12-13 Impact factor: 2.655
Authors: Carlos Calderón; Laura Balagué; Álvaro Iruin; Ander Retolaza; Jon Belaunzaran; Javier Basterrechea; Isabel Mosquera Journal: Aten Primaria Date: 2015-11-11 Impact factor: 1.137