Tailored Implementation Intervention for Managing Depressed Elderly Patients in Primary Care
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      Background The prevalence of depression is high and the elderly have an increased risk of
      developing a chronic course. International data suggest that depression in the elderly is
      under-recognised, the latency before clinicians provide a treatment plan is longer, and
      elderly patients with depression are not offered psychotherapy to the same degree as younger
      patients. Although recommendations for the treatment of elderly patients with depression
      exist, health care professionals adhere to these recommendations to a limited degree only.
      Investigators conducted a systematic review to identify recommendations for managing
      depression in the elderly and prioritised six recommendations. Investigators identified and
      prioritised determinants of practice related to implementation of these recommendations in
      primary care, and subsequently discussed and prioritised interventions to address the
      identified determinants. The objective of this study is to evaluate the effectiveness of
      these tailored implementation interventions to implement six recommendations for the
      management of elderly patients with depression in primary care.

      Methods/design Investigators will conduct a pragmatic cluster randomised trial comparing
      implementation of the six recommendations using tailored interventions with usual care.
      Investigators will randomize 80 municipalities into one of two groups: an intervention group,
      to which investigators will deliver tailored interventions to implement the six
      recommendations, and a control group, to which investigators will not deliver any
      intervention. Investigators will randomise municipalities rather than patients, individual
      clinicians or practices because we will deliver the intervention for the first three
      recommendations at the municipal level and investigators want to minimise the risk of
      contamination across practices for the other three recommendations. The primary outcome is
      the proportion of general practitioners' behaviours which are consistent with the
      recommendations.

      Discussion This trial will investigate whether a tailored implementation approach is an
      effective strategy to improve collaborative care in the municipalities and health care
      professionals' practice towards elderly patients with depression in primary care. The
      effectiveness evaluation described in this protocol will be accompanied with a process
      evaluation exploring why and how the interventions were effective or ineffective.
    


Intervention name(s): Implementation intervention
Intervention type(s): Other
Intervention description(s): Investigators will provide a comprehensive package of interventions to assist health care professionals to adhere to the recommendations. The package will include support for developing a collaborative care plan in the municipality, resources for general practitioners and other health care professionals, resources for patients, their relatives and volunteers,outreach visits to general practitioners' practices and their educational groups, educational resources and web-based resources.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Keywords: Tailored implementation interventions; Primary care; Depression in the elderly