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Completed

NCT Number: NCT02232854

Training and Supervision Program for Depression Management

According to the literature the management of depressive disorders at primary care level is not always consistent with guidelines. The main objective of this study is to test whether a Comprehensive Technology-Assisted Training and Supervision Program will improve depression management in Primary Health Care clinics in Santiago, Chile.

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Key information

Conditions

Depression Behavior Behavioral Symptoms

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

CESFAM Garín, Quinta Normal, Santiago Metropolitan, Chile

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About this study

A cluster randomized controlled clinical trial will be conducted in four Primary Health Care (PHC) clinics in Santiago, Chile.

The sample selection of the PHC clinics will be performed in two steps. Firstly, two urban municipalities of Santiago Metropolitan Region, Chile, will be randomly selected if they work with the Faculty of Medicine of the U.Chile and have at least two PHC.Municipalities with a high Human Development Index, high percentage of immigrants and older population, and Psychiatry residents working in PHC , will be excluded.Secondly in each selected municipalities,two PHC will be randomly selected for the active and control arm.

To detect a difference of 20%, in a one-sided model, with an alpha of 5% and power of 80%, 152 depressed persons, 76 to each group, will be required for the study. A design effect of 2.42 was estimated. After applying the design effect the sample needed increased to 368 depressed persons. Considering a retention rate of approximately 85%, 434 depressed cases will be needed required for the study, hence 109 cases in each of the 4 primary health care clinics.

Analysis and presentation of the results will be in accordance with CONSORT guidelines for randomized clinical trials, with the primary comparative analysis being conducted on an intention to treat basis and due emphasis placed on confidence intervals for the between-arm comparisons.

Initially descriptive analysis to assess the balance between two groups will be conducted. The primary analysis will employ multilevel multivariable lineal regression to investigate differences in the PHQ-9 scores between groups at 3 and 6 months after randomization, adjusting for baseline outcome variable scores. Sensitivity analysis making different assumptions will be conducted to investigate the potential effects of missing data. Similar analysis will be done for the secondary outcomes measures.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • signing written informed consent
  • age between 18-65 years
  • current depressive episode, according to the Mini-International Neuropsychiatric Interview (MINI)

Exclusion criteria

  • current depression treatment
  • no access to telephone

Treatment and study plan

Depression training/supervision program

Behavioral

The intervention will be composed of:

  • Training of Primary Health Care teams to ensure compliance to the "Clinical Guidelines of the Ministry of Health for the Treatment of Depression". Primary Health Care teams will undergo an Objective Structured Clinical Examination (OSCE) for evaluation.
  • After the training, a focus group between Primary Health Care teams and study researchers will be held in order to address barriers to clinical guidelines implementation.
  • Primary Health Care clinics' trained administrative staff will contact patients from a call-center to support treatment adherence.
  • Psychiatrists, using a web-based platform, will supervise the course of the program, the allocated treatments, the patients' progress, and their response to treatment.

Primary outcomes

  1. Change from Baseline Depressive Symptomatology at 3 months

    Time frame: Baseline , 3 months

    Depressive symptomatology measured with the Patient Health Questionnaire - Nine Item (PHQ-9) at 3 months after patient recruitment.

  2. Change from Baseline Depressive Symptomatology at 6 months

    Time frame: Baseline, 6 months.

    Depressive symptomatology measured with the Patient Health Questionnaire - Nine Item (PHQ-9) at 6 months after patient recruitment.

Secondary outcomes

  1. Adherence to depression treatment at patient's level

    Time frame: 3 and 6 months after baseline.

  2. Change from Baseline Quality of life at 3 and 6 months

    Time frame: Baseline , 3 months, 6 months.

    Quality of life at patient's level measured with the Health Survey, Short form (SF-36), at 3 months and 6 months after patient recruitment.

  3. Change from Baseline Clinical Outcomes at 3 and 6 months

    Time frame: Baseline , 3 months, 6 months.

    Clinical outcomes at patient's level measured with the Outcome Questionnaire-45.2 (OQ-45.2), at 3 months and 6 months after patient recruitment.

  4. Use of Health Care services at patient's level

    Time frame: 3 and 6 months after baseline

    Use of Health Care services at patient's level measured with and ad-hoc built questionnaire.

  5. Rate of treated depressed cases at Primary Care team level

    Time frame: 12 months before randomization and 12 months after.

Sponsors and collaborators

Lead sponsor

University of Chile

Other

Registry information

Official study title

Comprehensive Technology-Assisted Training and Supervision Program to Enhance Depression Management in Primary Care

Important dates

Study start
2014
Primary completion
2016
Study completion
2016
First posted
Sep 5, 2014
Registry last updated
Oct 25, 2017

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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