Systematic depression screening in high-risk patients attending primary care: a pragmatic cluster-randomized trial

BMC Psychiatry

Research Article

Silvia López¹  José Antonio Lozano²  Enric Aragonés³  José Ángel Arbesú⁴  Belen Yruretagoyena⁵  Inmaculada Gilaberte⁵  Irene Romera⁶  Sireesha Pamulapati⁷  Celso Iglesias-García⁸  Ángel L Montejo⁹ 

[1] Atención Primaria, Área 7 de Madrid, Madrid, Spain;Centro Jóse Antonio Lozano, Sevilla, Spain;Centro de Atención Primaria Constantí, Tarragona, Spain;Centro de Salud de la Eria, Oviedo, Spain;Clinical Research Department, Lilly, S.A., Avenida de la Industria, 30. Alcobendas, E-28108, Madrid, Spain;Clinical Research Department, Lilly, S.A., Avenida de la Industria, 30. Alcobendas, E-28108, Madrid, Spain;Universitat Autonoma de Barcelona, Barcelona, Spain;European Statistics, Lilly UK, Erl Wood Manor, Windlesham, Surrey, United Kingdom;Hospital Valle del Nalón, Centro de Salud Mental de Langreo, Langreo, Spain;University Hospital of Salamanca. IBSAL. Department of Psychiatry, University of Salamanca, Salamanca, Spain;

关键词: Major depressive disorder;    Guideline adherence;    Diagnosis;    Primary health care;    Screening;   

DOI  :  10.1186/1471-244X-13-83

 received in 2012-06-12, accepted in 2013-02-12,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundSystematic screening for depression in high-risk patients is recommended but remains controversial. The aim of this study was to assess the effectiveness of such screening in everyday clinical practice on depression recognition.MethodsA pragmatic, cluster randomized, controlled study that randomized primary care physicians (PCPs) in Spain either to an intervention or control group. The intervention group (35-PCPs) received training in depression screening and used depression screening routinely for at least 6 months. The control group (34-PCPs) managed depression in their usual manner. Adherence to (1–6; never-very frequently), feasibility (1–4; unfeasible-very feasible), and acceptance (1–5; very poor-very good) of the screening were evaluated. Underrecognition (primary outcome) and undertreatment rates of major depressive disorder (MDD) in the two groups were compared 6 months after randomization in a random sample of 3737 patients assigned to these PCPs using logistic regression adjusting for the clustering effect.ResultsNo significant differences were found for recognition rates (58.0% vs. 48.1% intervention vs. control; OR [95%CI] 1.40 [0.73-2.68], p = 0.309). The undertreatment rate did not differ significantly either (p = 0.390). The mean adherence to depression screening was 4.4 ± 1.0 (‘occasionally’), the mean feasibility was 3.1 ± 0.5 (‘moderately feasible’), and the mean acceptance was 4.2 ± 0.6 (‘good’).ConclusionsThis research was not able to show effectiveness of the systematic screening for MDD in high-risk patients on depression recognition in primary care. The poor adherence to screening implementation could partially explain the results. These reflect the difficulties of putting into practice the clinical guidelines usually based on interventional research.Trial registrationClinicaltrials.gov NCT01662817

【 授权许可】

CC BY   
© Romera et al.; licensee BioMed Central Ltd. 2013