Controlled Study About Implementation of a Computerized Depression Guideline in Primary Care
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 10
- 主要终点
- The rate of patients in which the instruments from the Computerized Depression Guideline were used.
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients over 18 years.
- •Diagnosis of major depression (F
- •**,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.
排除标准
- •Patients with diagnosed or suspected major depression treated by professionals who have not given their consent to participate in the study.
结局指标
主要结局
The rate of patients in which the instruments from the Computerized Depression Guideline were used.
时间窗: 18 months
次要结局
- Incidence of major depression patients registered in the electronical clinical record.(18 months)
- Total referrals to mental health specialists(18 months)
- Rates of suicide and suicide attempts(18 months)
- Use Rate of the recommended antidepressives for the guideline(18 months)
- Total health cost of depression(18 months)
- Rate of patients in clinical remission(18 months)
研究者
Diego J. Palao-VIdal
Mental Health Director
Corporacion Parc Tauli