Training and Supervision Program for Depression Management
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      According to the literature the management of depressive disorders at primary care level is
      not always consistent with guidelines. The main objective of this study is to test whether a
      Comprehensive Technology-Assisted Training and Supervision Program will improve depression
      management in Primary Health Care clinics in Santiago, Chile.
    

Detailed description: 
      A cluster randomized controlled clinical trial will be conducted in four Primary Health Care
      (PHC) clinics in Santiago, Chile.

      The sample selection of the PHC clinics will be performed in two steps. Firstly, two urban
      municipalities of Santiago Metropolitan Region, Chile, will be randomly selected if they work
      with the Faculty of Medicine of the U.Chile and have at least two PHC.Municipalities with a
      high Human Development Index, high percentage of immigrants and older population, and
      Psychiatry residents working in PHC , will be excluded.Secondly in each selected
      municipalities,two PHC will be randomly selected for the active and control arm.

      To detect a difference of 20%, in a one-sided model, with an alpha of 5% and power of 80%,
      152 depressed persons, 76 to each group, will be required for the study. A design effect of
      2.42 was estimated. After applying the design effect the sample needed increased to 368
      depressed persons. Considering a retention rate of approximately 85%, 434 depressed cases
      will be needed required for the study, hence 109 cases in each of the 4 primary health care
      clinics.

      Analysis and presentation of the results will be in accordance with CONSORT guidelines for
      randomized clinical trials, with the primary comparative analysis being conducted on an
      intention to treat basis and due emphasis placed on confidence intervals for the between-arm
      comparisons.

      Initially descriptive analysis to assess the balance between two groups will be conducted.
      The primary analysis will employ multilevel multivariable lineal regression to investigate
      differences in the PHQ-9 scores between groups at 3 and 6 months after randomization,
      adjusting for baseline outcome variable scores. Sensitivity analysis making different
      assumptions will be conducted to investigate the potential effects of missing data. Similar
      analysis will be done for the secondary outcomes measures.
    

Intervention name(s): Depression training/supervision program
Intervention type(s): Behavioral
Intervention description(s): The intervention will be composed of:
Training of Primary Health Care teams to ensure compliance to the "Clinical Guidelines of the Ministry of Health for the Treatment of Depression". Primary Health Care teams will undergo an Objective Structured Clinical Examination (OSCE) for evaluation.
After the training, a focus group between Primary Health Care teams and study researchers will be held in order to address barriers to clinical guidelines implementation.
Primary Health Care clinics' trained administrative staff will contact patients from a call-center to support treatment adherence.
Psychiatrists, using a web-based platform, will supervise the course of the program, the allocated treatments, the patients' progress, and their response to treatment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Depression