Strengthening Mental Health Care in Chronic Care Patients With Hypertension. A Cluster Randomised Control Trial
- Conditions
- HypertensionDepression
- Interventions
- Behavioral: PC101+Mental Health
- Registration Number
- NCT02425124
- Lead Sponsor
- University of KwaZulu
- Brief 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1052
Clinics
- Twenty (20) largest clinics providing chronic care Patients
- Receiving hypertensive treatment at time of enrolment
- Depressive symptoms as indicated by total score of 9 or more on PHQ-9
- Planning to reside in area for the next year
- Capable of actively engaging in interviewer-administered questionnaire at time of recruitment, 6 months and 12 months later
- Written consent to participate in the study
Clinics
- Clinics that do not provide Integrated Chronic Disease Management
- Small (<10 000 attendances/ year)
- Mobile or satellite
- Participated in piloting of intervention & data collection. Patients
- Inability to meet the above inclusion criteria
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention PC101+Mental Health PC101 + Mental Health 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. Control PC101+Mental Health PC101 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.
- Primary Outcome Measures
Name Time Method Depression 6 Months 50 % reduction in PHQ-9 score
- Secondary Outcome Measures
Name Time Method Antidepressant treatment 12 months Proportion with antidepressant treatment initiated or intensified
Blood pressure 6 months and 12 months Difference in means
Counselling 12 months Proportion receiving counselling by clinic-based counsellor
Disability 12 Months Mean score using the Manual for WHO Disability Schedule WHODAS 2.0 schedule
Productivity and economic outcomes 12 months Productivity and economic outcomes
Stress 12 Months Mean score using Perceived Stress Scale
Referral to specialist mental health worker/service 12 months Proportion referred
Diagnosis of other comorbid illnesses 12 months Proportion diagnosed
All cause mortality 12 months Proportion died
Retention in care 12 months Proportion in care
Cardiovascular risk factors 12 months Difference in means
Healthcare utilization 12 months Incidence rate ratio using linkage with hospitalisation databases
Quality of chronic illness care received 12 months Mean Patient Assessment of Care for Chronic Conditions (PACIC) score
Depression 6 months; 12 months Mean PHQ9 scores
Trial Locations
- Locations (1)
Primary Health Care Facilities
🇿🇦Dr Kenneth Kaunda District, North West Province, South Africa