Strengthening Mental Health Care in Chronic Care Patients With Hypertension. A Cluster Randomised Control Trial
Condition: Depression; Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      A pragmatic cluster randomized controlled trial (RCT) in 20 public sector primary care
      clinics in the Dr Kenneth Kaunda district of the North West Province of South Africa to
      assess mental health and health outcomes for depressed adults receiving hypertensive
      treatment by measuring the real-world effectiveness of a facility-based stepped care
      intervention combining stress and depression case detection and management by non-physician
      clinicians and referral pathways for anti-depressant medication and/or group/individual
      counselling delivered by lay-health workers for patients with depression. The control
      condition is enhanced usual primary health care where non-physician clinicians have been
      equipped with the basic skills to identify stress and depression/anxiety but with limited
      access to doctors authorized to prescribe antidepressant medication, and with no specific
      psychosocial interventions.
    

Detailed description: 
      Cardiovascular disease (hypertension and stroke) is the leading cause of mortality in the
      world and the second leading cause of death in Africa. Estimates by the WHO using disability
      adjusted life years (DALYs) suggest that NCDs were responsible for 28% of the total burden of
      disease in South Africa in 2004, with heart disease, diabetes and stroke together being
      responsible for the second most important cause of death in adult South Africans. In the
      investigators 2014 survey of 3 primary health care facilities in the North West Province
      where the Department of Health is piloting Integrated Chronic Disease Management the
      investigators found that of the 1 250 chronic care patients surveyed, 51% reported having
      hypertension. Spurring the rising burden of NCDs are mental disorders. One in 6 adults
      experience a common mental disorder (depression, anxiety disorders and substance use
      disorders) within a 12 month period (Herman et al., 2009), one in four receive treatment of
      any kind (Seedat et al., 2009). Depression co-exists with NCDs having a mutually reinforcing
      relationship compromising both prevention and treatment through exacerbating modifiable risk
      factors and compromising adherence and self-care respectively. Objectives: The investigators
      propose to strengthen the Primary Care 101 guidelines. This is a set of clinical guidelines
      and decision support for nurses developed for the identification and management of multiple
      chronic diseases.
    

Intervention name(s): PC101+Mental Health
Intervention type(s): Behavioral
Intervention description(s): Facility-based stepped care intervention combining stress and depression case detection and management by non-physician clinicians and referral pathways for anti-depressant medication and/or group/individual counselling delivered by lay-health workers for patients with depression.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research