Assessment of an Enhanced Program for Depression Management in Primary Care: a Cluster Randomized Controlled Trial. The INDI Project (Interventions for Depression Improvement)

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2007 Sep 22

PMID 17883845

Citations 7

Authors

Enric Aragones

Antonia Caballero

Josep Ll Pinol

German Lopez-Cortacans

Waleska Badia

Josep M Hernandez

Pilar Casaus

Silvia Folch

Josep Basora

Antonio Labad

Affiliations

Soon will be listed here.

Abstract

Background: Most 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/design:

Design: 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.

Discussion: The 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 Registration: ISRCTN16384353.

Citing Articles

Five Interpersonal Factors Are Predictive of the Response to Treatment of Major Depression With Antidepressants in Primary Care.

Salazar-Fraile J, Sempere-Verdu E, Perez-Hoyos S, Tabares-Seisdedos R, Gomez-Beneyto M Front Psychiatry. 2018; 9:416.

PMID: 30279665 PMC: 6153350. DOI: 10.3389/fpsyt.2018.00416.

Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

Aragones E, Palao D, Lopez-Cortacans G, Caballero A, Cardoner N, Casaus P BMC Health Serv Res. 2017; 17(1):821.

PMID: 29237444 PMC: 5729287. DOI: 10.1186/s12913-017-2774-2.

Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

Grochtdreis T, Brettschneider C, Wegener A, Watzke B, Riedel-Heller S, Harter M PLoS One. 2015; 10(5):e0123078.

PMID: 25993034 PMC: 4437997. DOI: 10.1371/journal.pone.0123078.

[The INDI (INterventions for Depression Improvement) model: an effective proposal to improve the clinical results of depression in primary care].

Aragones E, Caballero A, Pinol J Aten Primaria. 2013; 45(4):179-80.

PMID: 23473632 PMC: 6985503. DOI: 10.1016/j.aprim.2013.01.008.

Collaborative care for depression and anxiety problems.

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L Cochrane Database Syst Rev. 2012; 10:CD006525.

PMID: 23076925 PMC: 11627142. DOI: 10.1002/14651858.CD006525.pub2.

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