Controlled Study About Implementation of a Computerized Depression Guideline in Primary Care

Depression Clinical Trial

— GPC-DEPc  

Official title:

Controlled Study About Implementation of a Computerized Depression Guideline in Primary Care

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT02328833
• Other study ID #: SM-CSPT-DP2014-01
• Status: Not yet recruiting
• Phase: N/A
• First received: December 29, 2014
• Last updated: December 29, 2014
• Start date: January 2015
• Est. completion date: December 2016

Study information

• Verified date: December 2014
• Source: Corporacion Parc Tauli
• Contact: Diego J Palao
• Phone: 0034937458376
• Email: dpalao[@]tauli.cat
• Is FDA regulated: No
• Health authority: Spain: Ethics Committee
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 10
• Est. completion date: December 2016
• Est. primary completion date: June 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients over 18 years.

• Diagnosis of major depression (F32. **,F33.** according to International Classification of Diseases-10)

• Attended in any of the 10 selected Primary Care Centers (from Barcelona, Spain)

• Patients with suspected depression in which the diagnosis is discarded using the Guide.

Exclusion Criteria:

• Patients with diagnosed or suspected major depression treated by professionals who have not given their consent to participate in the study.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Depression
• Depressive Disorder

Intervention

Other:
• Experimental strategies of guidelines implementation
Experimental strategies of Depression Guidelines implementation in Primary Care Centers. The active process includes the establishment of local implementation teams, seminars, regular feedback and follow-up visits for four months.

Locations

Country	Name	City	State
n/a

Sponsors (4)

Lead Sponsor	Collaborator
Corporacion Parc Tauli	Hospital Clinic of Barcelona, Institut Catala de Salut, Instituto de Salud Carlos III

References & Publications (6)

Fernández A, Pinto-Meza A, Bellón JA, Roura-Poch P, Haro JM, Autonell J, Palao DJ, Peñarrubia MT, Fernández R, Blanco E, Luciano JV, Serrano-Blanco A. Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study. Gen Hosp Psychiatry. 2010 Mar-Apr;32(2):201-9. doi: 10.1016/j.genhosppsych.2009.11.015. Epub 2010 Jan 12. — View Citation

Pamias Massana M, Crespo Palomo C, Gisbert Gelonch R, Palao Vidal DJ. [The social cost of depression in the city of Sabadell (Barcelona, Spain) (2007-2008)]. Gac Sanit. 2012 Mar-Apr;26(2):153-8. doi: 10.1016/j.gaceta.2011.07.019. Epub 2011 Nov 3. Spanish. — View Citation

Serrano-Blanco A, Palao DJ, Luciano JV, Pinto-Meza A, Luján L, Fernández A, Roura P, Bertsch J, Mercader M, Haro JM. Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP). Soc Psychiatry Psychiatr Epidemiol. 2010 Feb;45(2):201-10. doi: 10.1007/s00127-009-0056-y. Epub 2009 May 19. — View Citation

Sonnenberg FA, Hagerty CG. Computer-interpretable clinical practice guidelines. Where are we and where are we going ? Yearb Med Inform. 2006:145-58. Review. — View Citation

Triñanes Y, Atienza G, Louro-González A, de-las-Heras-Liñero E, Alvarez-Ariza M, Palao DJ. Development and impact of computerised decision support systems for clinical management of depression: A systematic review. Rev Psiquiatr Salud Ment. 2015 Jul-Sep;8(3):157-66. doi: 10.1016/j.rpsm.2014.10.004. Epub 2014 Dec 12. English, Spanish. — View Citation

Weinmann S, Koesters M, Becker T. Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatr Scand. 2007 Jun;115(6):420-33. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The rate of patients in which the instruments from the Computerized Depression Guideline were used.	The rate of patients with possible depression treated in the analyzed period in which at least one of the instruments that the Guide recommended were used (to rule out or confirm the diagnosis, choose the optimal treatment or the best clinical follow-up option).	4 months	No
Primary	The rate of patients in which the instruments from the Computerized Depression Guideline were used.		6 months	No
Primary	The rate of patients in which the instruments from the Computerized Depression Guideline were used.		12 months	No
Primary	The rate of patients in which the instruments from the Computerized Depression Guideline were used.		18 months	No
Secondary	Incidence of major depression patients registered in the electronical clinical record.	New major depression cases (F32.**; F33.**) registered in the electronical clinical record.	6 months	No
Secondary	Incidence of major depression patients registered in the electronical clinical record.		12 months	No
Secondary	Incidence of major depression patients registered in the electronical clinical record.		18 months	No
Secondary	Rates of suicide and suicide attempts		18 months	No
Secondary	Total health cost of depression	Direct and indirect health cost of major depression patients registered in electronical clinical record	18 months	No
Secondary	Total referrals to mental health specialists		6 months	No
Secondary	Total referrals to mental health specialists		12 months	No
Secondary	Total referrals to mental health specialists		18 months	No
Secondary	Use Rate of the recommended antidepressives for the guideline		6 months	No
Secondary	Use Rate of the recommended antidepressives for the guideline		12 months	No
Secondary	Use Rate of the recommended antidepressives for the guideline		18 months	No
Secondary	Rate of patients in clinical remission	The clinical remission of depression symptoms is defined by a Patient Health Questionnaire-9 (PHQ-9) Score of < 5 points	6 months	No
Secondary	Rate of patients in clinical remission		12 months	No
Secondary	Rate of patients in clinical remission		18 months	No

External Links

•   Adaptation to the Catalan Health Model of the Clinical Practice Guideline for Depression in Adults Patients of the National Health Spanish System (2010)
•   Clinical Practice Guideline for Depression in Adults Patients of the National Health Spanish System (2014)