Controlled Study About Implementation of a Computerized Depression Guideline in Primary Care (GPC-DEPc)

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.

Study Overview

• Status: Unknown
• Conditions: Depression
• Intervention / Treatment: Other: Experimental strategies of guidelines implementation

Detailed 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.

• Study Type: Interventional
• Enrollment (Anticipated): 10
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Diego J Palao; Phone Number: 0034937458376; Email: dpalao@tauli.cat

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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 Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Active Implementation of Guidelines; Primary Care Centers where the experimental strategies of guidelines implementation will be done	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.
No Intervention: No Active Implementation of Guidelines; Primary Care Centers where the experimental strategies of guidelines implementation not will be done

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Corporacion Parc Tauli
• Collaborators: Hospital Clinic of Barcelona; Instituto de Salud Carlos III; Institut Catala de Salut
• Investigators: Principal Investigator: Diego J Palao, Corporacion Parc Taulí Sabadell, University Hospital (Barcelona, Spain)

Publications and helpful links

General Publications

• 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. doi: 10.1111/j.1600-0447.2007.01016.x.
• Serrano-Blanco A, Palao DJ, Luciano JV, Pinto-Meza A, Lujan L, Fernandez 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.
• Fernandez A, Pinto-Meza A, Bellon JA, Roura-Poch P, Haro JM, Autonell J, Palao DJ, Penarrubia MT, Fernandez 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.
• Trinanes Y, Atienza G, Louro-Gonzalez A, de-las-Heras-Linero 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.
• 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.
• Sonnenberg FA, Hagerty CG. Computer-interpretable clinical practice guidelines. Where are we and where are we going ? Yearb Med Inform. 2006:145-58.

Helpful Links

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

Study record dates

Study Major Dates

• Study Start: January 1, 2015
• Primary Completion (Anticipated): June 1, 2016
• Study Completion (Anticipated): December 1, 2016

Study Registration Dates

• First Submitted: December 29, 2014
• First Submitted That Met QC Criteria: December 29, 2014
• First Posted (Estimate): December 31, 2014

Study Record Updates

• Last Update Posted (Estimate): December 31, 2014
• Last Update Submitted That Met QC Criteria: December 29, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: Depression; Implementation; Primary Care; Clinical Practice Guideline; Computerized Guideline
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Depression; Depressive Disorder
• Other Study ID Numbers: SM-CSPT-DP2014-01