Improving Depression Outcomes Among Australian Primary Care Patients: Protocol for a Cluster Randomised Controlled Trial

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 Feb 13

PMID 32047011

Citations 3

Authors

Mariko Carey

Rob Sanson-Fisher

Nick Zwar

Danielle Mazza

Graham Meadows

Leon Piterman

Amy Waller

Justin Walsh

Christopher Oldmeadow

Simon Deeming

Andrew Searles

Frans Henskens

Brian Kelly

Affiliations

Soon will be listed here.

Abstract

Introduction: Depression is a common and debilitating condition. In Australia, general practitioners (GPs) are the key providers of depression care. However, available evidence suggests that case finding for depression in primary care is poor. This study will examine whether a systematic approach to screening for depression and assessing patient preferences for depression care improves depression outcomes among primary care patients.

Methods And Analysis: A cluster randomised controlled design will be used with general practice clinics randomly assigned to either the intervention (n=12) or usual care group (n=12). Patients who are aged 18 and older, presenting for general practice care, will be eligible to participate. Eighty-three participants will be recruited at each clinic. Participants will be asked to complete a baseline survey administered on a touch screen computer at their GP clinic, and then a follow-up survey at 3, 6 and 12 months. Those attending usual care practices will receive standard care. GPs at intervention practices will complete an online Clinical e-Audit, and will be provided with provider and patient-directed resources for depression care. Patients recruited at intervention practices who score 10 or above on the Patient Health Questionnaire-9 will have feedback regarding their depression screening results and preferences for care provided to their GP. The primary analysis will compare the number of cases of depression between the intervention and control groups.

Ethics And Dissemination: The study has been approved by the University of Newcastle Human Research Ethics Committee, and registered with Human Research Ethics Committees of the University of Wollongong, Monash University and University of New South Wales. Results will be disseminated through peer-reviewed journal publications and conference presentations.

Trial Registration Number: ACTRN12618001139268; Pre-results.

Citing Articles

Prioritising and incentivising productivity within indicator-based approaches to Research Impact Assessment: a commentary.

Deeming S, Hure A, Attia J, Nilsson M, Searles A Health Res Policy Syst. 2023; 21(1):136.

PMID: 38110938 PMC: 10726490. DOI: 10.1186/s12961-023-01082-7.

Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review.

Roberts B, Cooper Z, Lu S, Stanley S, Majda B, Collins K Front Pharmacol. 2023; 14:1267294.

PMID: 37795032 PMC: 10545970. DOI: 10.3389/fphar.2023.1267294.

Shared decision-making interventions for people with mental health conditions.

Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y Cochrane Database Syst Rev. 2022; 11:CD007297.

PMID: 36367232 PMC: 9650912. DOI: 10.1002/14651858.CD007297.pub3.

References

Huo T, Guo Y, Shenkman E, Muller K . Assessing the reliability of the short form 12 (SF-12) health survey in adults with mental health conditions: a report from the wellness incentive and navigation (WIN) study. Health Qual Life Outcomes. 2018; 16(1):34. PMC: 5811954. DOI: 10.1186/s12955-018-0858-2. View

Mitchell A, Yadegarfar M, Gill J, Stubbs B . Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. BJPsych Open. 2016; 2(2):127-138. PMC: 4995584. DOI: 10.1192/bjpo.bp.115.001685. View

Bergus G, Hartz A, Noyes Jr R, Ward M, James P, Vaughn T . The limited effect of screening for depressive symptoms with the PHQ-9 in rural family practices. J Rural Health. 2005; 21(4):303-9. DOI: 10.1111/j.1748-0361.2005.tb00099.x. View

Gilbody S, House A, Sheldon T . Screening and case finding instruments for depression. Cochrane Database Syst Rev. 2005; (4):CD002792. PMC: 6769050. DOI: 10.1002/14651858.CD002792.pub2. View

Schulz K, Altman D, Moher D . CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2011; 1(2):100-7. PMC: 3043330. DOI: 10.4103/0976-500X.72352. View

Simon G, Rutter C, Peterson D, Oliver M, Whiteside U, Operskalski B . Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death?. Psychiatr Serv. 2013; 64(12):1195-202. PMC: 4086215. DOI: 10.1176/appi.ps.201200587. View

Carey M, Jones K, Meadows G, Sanson-Fisher R, DEste C, Inder K . Accuracy of general practitioner unassisted detection of depression. Aust N Z J Psychiatry. 2014; 48(6):571-8. PMC: 4230951. DOI: 10.1177/0004867413520047. View

Lin P, Campbell D, Chaney E, Liu C, Heagerty P, Felker B . The influence of patient preference on depression treatment in primary care. Ann Behav Med. 2005; 30(2):164-73. DOI: 10.1207/s15324796abm3002_9. View

Harrison C, Britt H, Charles J . Better Outcomes or Better Access -- which was better for mental health care?. Med J Aust. 2012; 197(3):170-2. DOI: 10.5694/mja12.10555. View

10.

Dorow M, Lobner M, Pabst A, Stein J, Riedel-Heller S . Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients. Front Psychiatry. 2018; 9:181. PMC: 5966543. DOI: 10.3389/fpsyt.2018.00181. View

11.

Williams Jr J, Mulrow C, Kroenke K, Dhanda R, Badgett R, Omori D . Case-finding for depression in primary care: a randomized trial. Am J Med. 1999; 106(1):36-43. DOI: 10.1016/s0002-9343(98)00371-4. View

12.

Moradveisi L, Huibers M, Renner F, Arntz A . The influence of patients' preference/attitude towards psychotherapy and antidepressant medication on the treatment of major depressive disorder. J Behav Ther Exp Psychiatry. 2013; 45(1):170-7. DOI: 10.1016/j.jbtep.2013.10.003. View

13.

Jarjoura D, Polen A, Baum E, Kropp D, Hetrick S, Rutecki G . Effectiveness of screening and treatment for depression in ambulatory indigent patients. J Gen Intern Med. 2004; 19(1):78-84. PMC: 1494675. DOI: 10.1111/j.1525-1497.2004.21249.x. View

14.

Rost K, Nutting P, Smith J, Werner J, Duan N . Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming. J Gen Intern Med. 2001; 16(3):143-9. PMC: 1495192. DOI: 10.1111/j.1525-1497.2001.00537.x. View

15.

Wells K, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unutzer J . Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000; 283(2):212-20. DOI: 10.1001/jama.283.2.212. View

16.

Sanderson K, Andrews G . The SF-12 in the Australian population: cross-validation of item selection. Aust N Z J Public Health. 2002; 26(4):343-5. DOI: 10.1111/j.1467-842x.2002.tb00182.x. View

17.

Mitchell A, Vaze A, Rao S . Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009; 374(9690):609-19. DOI: 10.1016/S0140-6736(09)60879-5. View

18.

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

19.

OConnor E, Whitlock E, Beil T, Gaynes B . Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med. 2009; 151(11):793-803. DOI: 10.7326/0003-4819-151-11-200912010-00007. View