title: Targeted versus tailored multimedia patient engagement to enhance depression recognition and treatment in primary care: randomized controlled trial protocol for the AMEP2 study.
abstract: BACKGROUND
  Depression in primary care is common, yet this costly and disabling condition remains underdiagnosed and undertreated. Persisting gaps in the primary care of depression are due in part to patients' reluctance to bring depressive symptoms to the attention of their primary care clinician and, when depression is diagnosed, to accept initial treatment for the condition. Both targeted and tailored communication strategies offer promise for fomenting discussion and reducing barriers to appropriate initial treatment of depression.
  
  
  METHODS
  The Activating Messages to Enhance Primary Care Practice (AMEP2) Study is a stratified randomized controlled trial comparing two computerized multimedia patient interventions -- one targeted (to patient gender and income level) and one tailored (to level of depressive symptoms, visit agenda, treatment preferences, depression causal attributions, communication self-efficacy and stigma)-- and an attention control. AMEP2 consists of two linked sub-studies, one focusing on patients with significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores ≥ 5), the other on patients with few or no depressive symptoms (PHQ-9 < 5). The first sub-study examined effectiveness of the interventions; key outcomes included delivery of components of initial depression care (antidepressant prescription or mental health referral). The second sub-study tracked potential hazards (clinical distraction and overtreatment). A telephone interview screening procedure assessed patients for eligibility and oversampled patients with significant depressive symptoms. Sampled, consenting patients used computers to answer survey questions, be randomized, and view assigned interventions just before scheduled primary care office visits. Patient surveys were also collected immediately post-visit and 12 weeks later. Physicians completed brief reporting forms after each patient's index visit. Additional data were obtained from medical record abstraction and visit audio recordings. Of 6,191 patients assessed, 867 were randomized and included in analysis, with 559 in the first sub-study and 308 in the second.
  
  
  CONCLUSIONS
  Based on formative research, we developed two novel multimedia programs for encouraging patients to discuss depressive symptoms with their primary care clinicians. Our computer-based enrollment and randomization procedures ensured that randomization was fully concealed and data missingness minimized. Analyses will focus on the interventions' potential benefits among depressed persons, and the potential hazards among the non-depressed.
  
  
  BACKGROUND
  ClinicialTrials.gov Identifier: NCT01144104.
authors.affiliation: UC Davis Department of Pediatrics and Center for Healthcare Policy and Research, 2103 Stockton Blvd Suite 2224, Sacramento, CA 95817, USA. djtancredi@ucdavis.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: Christina K
authors.initials: CK
authors.lastname: Slee
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
authors.forename: Jasmine
authors.initials: J
authors.lastname: Nettiksimmons
authors.forename: Camille
authors.initials: C
authors.lastname: Cipri
authors.forename: Dustin
authors.initials: D
authors.lastname: Gottfeld
authors.forename: Julia
authors.initials: J
authors.lastname: Huerta
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Feldman
authors.forename: Maja
authors.initials: M
authors.lastname: Jackson-Triche
authors.forename: Steven
authors.initials: S
authors.lastname: Kelly-Reif
authors.forename: Andrew
authors.initials: A
authors.lastname: Hudnut
authors.forename: Sarah
authors.initials: S
authors.lastname: Olson
authors.forename: Janie
authors.initials: J
authors.lastname: Shelton
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005006:Ethnicity / Q000193:education; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D019212:Multimedia / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted
chemical_list: D000928:Antidepressive Agents