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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Depression

Intervention / Treatment
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* Other: Experimental strategies of guidelines implementation


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Active Implementation of Guidelines<br>Primary Care Centers where the experimental strategies of guidelines implementation will be done | Other: Experimental strategies of guidelines implementation<br>* 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.<br>|
| No Intervention: No Active Implementation of Guidelines<br>Primary Care Centers where the experimental strategies of guidelines implementation not will be done | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| The rate of patients in which the instruments from the Computerized Depression Guideline were used. |  | 6 months | 
| The rate of patients in which the instruments from the Computerized Depression Guideline were used. |  | 12 months | 
| The rate of patients in which the instruments from the Computerized Depression Guideline were used. |  | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| Incidence of major depression patients registered in the electronical clinical record. |  | 12 months | 
| Incidence of major depression patients registered in the electronical clinical record. |  | 18 months | 
| Rates of suicide and suicide attempts |  | 18 months | 
| Total health cost of depression | Direct and indirect health cost of major depression patients registered in electronical clinical record | 18 months | 
| Total referrals to mental health specialists |  | 6 months | 
| Total referrals to mental health specialists |  | 12 months | 
| Total referrals to mental health specialists |  | 18 months | 
| Use Rate of the recommended antidepressives for the guideline |  | 6 months | 
| Use Rate of the recommended antidepressives for the guideline |  | 12 months | 
| Use Rate of the recommended antidepressives for the guideline |  | 18 months | 
| 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 | 
| Rate of patients in clinical remission |  | 12 months | 
| Rate of patients in clinical remission |  | 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Depression, Clinical Practice Guideline, Implementation, Primary Care, Computerized Guideline