Tailored interventions to implement recommendations for elderly patients with depression in primary care: a study protocol for a pragmatic cluster randomised controlled trial

Trials

Signe A Flottorp²  Andrew D Oxman¹  Michel Wensing³  Jan Odgaard-Jensen¹  Ingeborg Granlund¹  Eivind Aakhus¹ 

[1] Norwegian Knowledge Centre for the Health Services, Box 7004, St Olavs plass, N-0130 Oslo, Norway;The Department of Health Management and Health Economics, University of Oslo, PO Box 1130, Blindern, 0318 Oslo, Norway;Radboud University Nijmegen Medical Centre, PO Box 9102, 6500 HC Nijmegen, The Netherlands

关键词: Cluster randomised trial;    Implementation science;    Tailored interventions;    Primary care;    Elderly;    Depression;   

Others  :  807672
DOI  :  10.1186/1745-6215-15-16

 received in 2013-07-31, accepted in 2013-12-09,  发布年份 2014

【 摘 要 】

Background

The prevalence of depression is high and the elderly have an increased risk of developing chronic course. International data suggest that depression in the elderly is under-recognised, the latency before clinicians provide a treatment plan is longer and elderly patients with depression are not offered psychotherapy to the same degree as younger patients. Although recommendations for the treatment of elderly patients with depression exist, health-care professionals adhere to these recommendations to a limited degree only. We conducted a systematic review to identify recommendations for managing depression in the elderly and prioritised six recommendations. We identified and prioritised the determinants of practice related to the implementation of these recommendations in primary care, and subsequently discussed and prioritised interventions to address the identified determinants. The objective of this study is to evaluate the effectiveness of these tailored interventions for the six recommendations for the management of elderly patients with depression in primary care.

Methods/design

We will conduct a pragmatic cluster randomised trial comparing the implementation of the six recommendations using tailored interventions with usual care. We will randomise 80 municipalities into one of two groups: an intervention group, to which we will deliver tailored interventions to implement the six recommendations, and a control group, to which we will not deliver any intervention. We will randomise municipalities rather than patients, individual clinicians or practices, because we will deliver the intervention for the first three recommendations at the municipal level and we want to minimise the risk of contamination across GP practices for the other three recommendations. The primary outcome is the proportion of actions taken by GPs that are consistent with the recommendations.

Discussion

This trial will investigate whether a tailored implementation approach is an effective strategy for improving collaborative care in the municipalities and health-care professionals’ practice towards elderly patients with depression in primary care. The effectiveness evaluation described in this protocol will be accompanied with a process evaluation exploring why and how the interventions were effective or ineffective.

Trial registration

ClinicalTrials.gov: NCT01913236

【 授权许可】

   
2014 Aakhus et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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