Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project (Interventions for Depression Improvement).
BACKGROUND
Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management.


METHODS



METHODS
A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression.


METHODS
20 primary care centres in the province of Tarragona (Spain)


METHODS
400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV) and who need to initiate antidepressant treatment


METHODS
A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface.


METHODS
The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial). These interviews will be given at 0, 3, 6 and 12 months.


METHODS
Severity of the depressive symptoms, response rate and remission rate.


METHODS
Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster.


CONCLUSIONS
The effectiveness of caring for depression in primary care can be improved by various strategies. The most effective models involve organisational changes and a greater role of nurses. However, these models are almost exclusively from the USA, and this randomized clinical trial will determine if this approach could be effective to improve the outcomes of depression in primary care in the Spanish health care system.


BACKGROUND
ISRCTN16384353.
Aragonès
Enric
E
Tarragona-Reus Primary Care Area, Catalan Health Institute, Spain. earagones.tarte.ics@gencat.net
Caballero
Antonia
A
Piñol
Josep Ll
JL
López-Cortacans
Germán
G
Badia
Waleska
W
Hernández
Josep M
JM
Casaus
Pilar
P
Folch
Sílvia
S
Basora
Josep
J
Labad
Antonio
A
D000293:Adolescent; D000328:Adult; D019090:Case Management; D016000:Cluster Analysis; D003865:Major Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D013030:Spain; D011795:Surveys and Questionnaires