title: Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial.
abstract: BACKGROUND
  Anxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system.In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the "Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care" (SMADS)-Study.
  
  
  METHODS
  The study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment.
  
  
  CONCLUSIONS
  The SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance their expected self-efficacy, reduce their symptom load and engage in more self-help activities to deal with their everyday lives. After successfully evaluating this psychosocial intervention, a new health care model for the management of symptoms of anxiety, depression and somatoform disorders for ambulatory patients could emerge, supplementing the work of the GP.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier: NCT01726387.
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg 20246, Germany. t.zimmermann@uke.uni-hamburg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zimmermann
authors.forename: Egina
authors.initials: E
authors.lastname: Puschmann
authors.forename: Martin
authors.initials: M
authors.lastname: Ebersbach
authors.forename: Anne
authors.initials: A
authors.lastname: Daubmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Steinmann
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy*; D019090:Case Management; D003695:Delivery of Health Care; D003863:Depression / Q000628:therapy*; D005260:Female; D005858:Germany; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D013001:Somatoform Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult