Depression Clinical Trial
Official title:
Controlled Study About Implementation of a Computerized Depression Guideline in Primary Care
The aim of this study is to evaluate the effects of an active multifactor implementation process of a Computerized Depression Guideline in Primary Care. The CPG-DEPc use use, the key outcomes and its maintenance over time in patients and professionals will be analyzed.
The application of scientific evidence on major depression in clinical practice is complex.
Many studies show that over 50% of depressed patients in primary care do not receive proper
attention, or are ineffective or potentially harmful treatments. In general, the process of
dissemination and implementation of Clinical Practice Guidelines (CPG) in printed version
induce a minor improvement in clinical practice. The adaptation of the CPG of Major
Depression in Adults (CPG-DEPC) in Catalonia (Spain), as a computerized integrated version,
offers an extraordinary opportunity to improve outcomes in Primary Care. The integrated
design allows precise access to help in the visit itself, to improve diagnosis validation
process, the recommended treatment and facilitate monitoring and evaluation of suicide risk
in depressed patients.
This study aims to evaluate the effects of an active multifactor implementation process of a
Computerized Depression Guideline in Primary Care. The GPC-DEPc use, the key outcomes and
its maintenance over time in patients and professionals will be analyzed.
A cluster randomized trial, multicenter study in ten Primary Care Centers in Barcelona,
coordinated by the same Mental Health Service, will be done. In five of the Centers will be
actively implemented the CPG-DEPc and the other five will proceed as usual process, as a
reference. The active process includes the establishment of local implementation teams,
seminars, regular feedback and follow-up visits for four months. The main outcome will be
the rate of patients with possible depression treated in the analyzed period in which at
least were used any of the instruments that the Guide recommended (to rule out or confirm
the diagnosis, choose the optimal treatment or follow-up the clinical maintenance best
options). Other professionals and patients secondary outcome measures will be analyzed
(incidence of major depression registers, referrals to mental health specialists, use of
recommended antidepressants and rates of patients in clinical remission). At the end of the
study, the suicide and suicide attempts rate and the data about the direct and indirect
health cost will be analyzed.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
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