Comprehensive technology-assisted training and supervision program to enhance depression management in primary care in Santiago, Chile: study protocol for a cluster randomized controlled trial

Graciela Rojas, Pablo Martínez, Paul A Vöhringer, Vania Martínez, Ariel Castro-Lara, Rosemarie Fritsch, Graciela Rojas, Pablo Martínez, Paul A Vöhringer, Vania Martínez, Ariel Castro-Lara, Rosemarie Fritsch

Abstract

Background: Depression is a common and disabling condition. Since 2001, Chile has had a national program for depression in primary care and universal access to treatment for depressed people over the age of 15. There are National Guidelines to treat depression but no training program exists. The aim of the present study protocol is to measure the effectiveness of a comprehensive technology-assisted training and supervision program to enhance depression management in primary care.

Methods and design: This is a two-arm, single-blind, cluster randomized controlled trial to compare the efficacy of the program versus usual care to treat depression in primary care clinics. In total, 434 depressed persons 18 to 65 years of age, recruited from four primary care clinics located in Santiago, will participate in the study.

Discussion: In order to ensure the quality of interventions supported by the national program for depression in Chile, it is desirable to have training programs of proven effectiveness.

Trial registration: NCT02232854, registered on 2 September 2014.

References

    1. Murray CJ, Lopez AD. The Global Burden of Disease: a comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990 and projected to 2020. Global Burden of Disease and Injury Series, vol. I. Cambridge, MA: Harvard School of Public Health; 1996.
    1. Araya R, Rojas G, Fritsh R, Acuña J, Lewis G. Common mental disorders in Santiago, Chile: Prevalence and socio-demographic correlates. Br J Psychiatry. 2001;178:228–33. doi: 10.1192/bjp.178.3.228.
    1. Vicente B, Rioseco P, Valdivia S, Kohn R, Torres S. Estudio chileno de prevalencia de patología psiquiátrica (DSM-III-R/CIDI) (ECPP) Rev Med Chile. 2002;130:527–36. doi: 10.4067/S0034-98872002000500007.
    1. Goldberg DP, Lecrubier Y. Form and Frequency of Mental Disorders Across Centres. In: Üstün TB, Sartorius N, editors. Mental Illness in General Health Care: An International Study. Chichester. Chichester: John Wiley & Sons on behalf of WHO; 1995. pp. 323–34.
    1. Rojas G, Araya R, Fritsch R. Salud Mental, problemas psicosociales y atención primaria de salud. Acta Psiquiatr Psicol Am Lat. 2000;46(2):119–26.
    1. Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De Silva M, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370(9591):991–1005. doi: 10.1016/S0140-6736(07)61240-9.
    1. National Collaborating Centre for Mental Health . Depression: The treatment and Management of Depression in Adults. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists [NICE Guideline]; 2012.
    1. Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, et al. Treating depression in primary care in low income women in Santiago, Chile: a randomized controlled trial. Lancet. 2003;361(9362):995–1000. doi: 10.1016/S0140-6736(03)12825-5.
    1. Araya R, Flynn T, Rojas G, Fritsch R, Simon G. Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago. Chile Am J Psychiatry. 2006;163(8):1379–87. doi: 10.1176/appi.ajp.163.8.1379.
    1. de Salud M. Guía Clínica Depresión en personas de 15 años y más. Santiago: MINSAL; 2013.
    1. Ministerio de Salud: Segundo Régimen de Garantías Explícitas en Salud [].
    1. Ministerio de Salud: Departamento de Estadísticas e Información de Salud [].
    1. de Salud M. Guía Clínica Tratamiento de Personas con Depresión. Santiago: MINSAL; 2009.
    1. Alvarado R, Vega J, Sanhueza G, Muñoz MG. Evaluación del programa para la detección, diagnóstico y tratamiento integral de la depresión en atención primaria, en Chile. Rev Panam Salud Publica. 2005;18(4/5):278–86.
    1. Alvarado R, Rojas G. El Programa Nacional para el diagnóstico y tratamiento de depresión en Atención Primaria: una evaluación necesaria. Rev Med Chile. 2011;139(5):592–9. doi: 10.4067/S0034-98872011000500005.
    1. Kessler D, Lloyd K, Lewis G, Gray DP. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ. 1999;318(7181):436–9. doi: 10.1136/bmj.318.7181.436.
    1. Simon GE, Vonkorff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995;4(2):99–105. doi: 10.1001/archfami.4.2.99.
    1. Lin EH, Simon GE, Katzelnick DJ, Pearson SD. Does physician education on depression management improve treatment in primary care? J Gen Intern Med. 2001;16(9):614–9. doi: 10.1046/j.1525-1497.2001.016009614.x.
    1. Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, et al. Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet. 2000;355(9199):185–91. doi: 10.1016/S0140-6736(99)03171-2.
    1. Katon W, Russo J, Von Korff M, Lin E, Simon G, Bush T, et al. Long-term effects of a collaborative care intervention in persistently depressed primary care patients. J Gen Intern Med. 2002;17(10):741–8. doi: 10.1046/j.1525-1497.2002.11051.x.
    1. Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA. 2003;289(23):3145–51. doi: 10.1001/jama.289.23.3145.
    1. Addington D, Kyle T, Desai S, Wang J. Facilitators and barriers to implementing quality measurement in primary mental health care: Systematic review. Can Fam Physician. 2010;56(12):1322–31.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Kroenke K, Spitzer RL, Williams JB, Lowe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59. doi: 10.1016/j.genhosppsych.2010.03.006.
    1. Baader T, Molina JL, Venezian S, Rojas C, Farías R, Fierro-Freixenet C, et al. Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria. Rev Chil Neuro-Psiquiat. 2012;50(1):10–22. doi: 10.4067/S0717-92272012000100002.
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36) (I). Conceptual framework and item selection. Med Care. 1992;30:473–83. doi: 10.1097/00005650-199206000-00002.
    1. Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ. 2002;324:1417. doi: 10.1136/bmj.324.7351.1417.
    1. Olivares P: Perfil del Estado de salud de beneficiarios del Sistema Isapres: Informe preliminar [].
    1. Rojas G, Fritsch R, Solís J, González M, Guajardo V, Araya R. Calidad de vida de mujeres deprimidas en el posparto. Rev Med Chile. 2006;134(6):713–20. doi: 10.4067/S0034-98872006000600006.
    1. Rojas G, Fritsch R, Solis J, Jadresic E, Castillo C, González M, et al. Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet. 2007;370(9599):1629–37. doi: 10.1016/S0140-6736(07)61685-7.
    1. Lambert MJ, Burlingame GM, Umphress V, Hansen NB, Vermeersch DA, Clouse GC, et al. The reliability and validity of the Outcome Questionnaire. Clin Psychol Psychot. 1996;3:249–58. doi: 10.1002/(SICI)1099-0879(199612)3:4<249::AID-CPP106>;2-S.
    1. Lambert MJ, Kahler M, Harmon C, Burlingame GM, Shimokawa K. Administration & scoring manual for the Outcome Questionnaire-45.2. Salt Lake City: OQMeasures; 2011.
    1. De la Parra G, Von Bergen A, Del Río M. Primeros hallazgos de la aplicación de un instrumento que mide resultados psicoterapéuticos en una muestra de pacientes y de población general. Rev Chil Neuro-Psiquiat. 2002;40:201–9.
    1. Correa J, Florenzano R, Rojas P, Labra J, Del Río V, Pastén J. El uso del cuestionario OQ-45.2 como indicador de psicopatología y de mejoría en pacientes psiquiátricos hospitalizados. Rev Chil Neuro-Psiquiat. 2006;44:258–62. doi: 10.4067/S0717-92272006000400004.
    1. Florenzano R, Artero M, González I, Martínez X, Ortega P. Evaluación del impacto de las intervenciones psicosociales en el nivel hospitalario de una Red de Atención de Salud Mental: aplicación sistemática del OQ 45.2 de Lambert. Rev Arg Clín Neuropsiquiátr. 2005;12:3–10.
    1. Fritsch R, Araya R, Solis J, Montt ME, Pilowsky D, Rojas G. Ensayo clínico randomizado de farmacoterapia con monitorización telefónica para mejorar el tratamiento de la depresión en la atención primaria en Santiago. Chile Rev Med Chile. 2007;135:587–95.
    1. Corp IBM. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp; 2011.
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. Lancet. 2001;357:1191–4. doi: 10.1016/S0140-6736(00)04337-3.
    1. Levav I, Kohn R, Montoya I, Palacio C, Rozic P, Solano I, et al. Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial. Psychol Med. 2005;35(1):35–45. doi: 10.1017/S0033291704002764.

Source: PubMed

3
購読する