Active Implementation of a Computerized CPG for Major Depression in Primary Care: 18-month Follow-up

OBJECTIVE: To describe the demographic and clinical characteristics, adequacy of antidepressant treatment, and changes in quality of life of patients with major depression receiving follow-up care from primary care centers. METHOD: A cohort study was performed in which major depression patients were followed-up over a nine-month period. Several evaluation instruments were used, including the World Health Organization Quality of Life and the Quality of Life-Depression, Centers for Epidemiologic Studies-Depression questionnaires. RESULTS: The sample comprised 179 individuals, mostly female (73%), with a mean age of 38 years and mean education of 9 years. At the end of the follow-up period, 42% of the individuals still presented with major depression, 25% had complete symptom remission, and only 9% were properly treated with antidepressants. In relation to quality of life, there were significant differences especially between baseline and after nine months in almost all measures. CONCLUSION: This study demonstrated that depressive symptoms are poorly recognized and that treatment is often inadequate for patients followed-up in primary care units in the south of Brazil. Most of the patients continued to have symptoms of depression over the nine-month period which were associated with impaired quality of life.

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Justification and active guideline implementation for spine radiography referrals in primary care

Acta Radiologica ◽

10.1177/0284185116661879 ◽

2016 ◽

Vol 58 (5) ◽

pp. 586-592 ◽

Cited By ~ 11

Author(s):

Pirita Tahvonen ◽

Heljä Oikarinen ◽

Jaakko Niinimäki ◽

Esa Liukkonen ◽

Seija Mattila ◽

...

Keyword(s):

Primary Care ◽

Lumbar Spine ◽

Guideline Implementation ◽

Public Health Problem ◽

Further Education ◽

Major Public Health Problem ◽

Spine Radiography ◽

Cervical Spine Radiography ◽

Active Implementation

Background Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% ( P < 0.001), thoracic spine by 53% ( P < 0.001), and lumbar spine by 47% ( P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified ( P = 0.005). Conclusion Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

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Major depression and its correlates in primary care settings in six countries

The British Journal of Psychiatry ◽

10.1192/bjp.186.1.41 ◽

2005 ◽

Vol 186 (1) ◽

pp. 41-47 ◽

Cited By ~ 33

Author(s):

Marcelo Pio De Almeida Fleck ◽

Gregory Simon ◽

Helen Herrman ◽

Donald Bushnell ◽

Mona Martin ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Logistic Regression ◽

Major Depression ◽

Complete Remission ◽

Life Events ◽

Scale Score ◽

Depression Scale

BackgroundFew published studies address depression outcomes in primary care from a cross-cultural perspective.AimsTo define baseline factors associated with 9-month clinical outcome: across six countries.MethodAdults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model.ResultsRates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variation in predictors across sites was not statistically significant.ConclusionsThe two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

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Estimating remission from untreated major depression: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s0033291712001717 ◽

2012 ◽

Vol 43 (8) ◽

pp. 1569-1585 ◽

Cited By ~ 130

Author(s):

H. A. Whiteford ◽

M. G. Harris ◽

G. McKeon ◽

A. Baxter ◽

C. Pennell ◽

...

Keyword(s):

Primary Care ◽

Major Depression ◽

Meta Analysis ◽

Severe Depression ◽

Spontaneous Remission ◽

Lower Probability ◽

Wait List ◽

Observational Cohort ◽

Study Type

BackgroundFew studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity.MethodWait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ⩽2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure.ResultsWait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months.ConclusionsIt is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.

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Efficacy of an active implementation process of a computerized CPG of major depression disorder in primary care

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.763 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S545-S545 ◽

Cited By ~ 2

Author(s):

M. Cavero ◽

J.A. Monreal ◽

N. Cardoner ◽

M.D. Moreno ◽

V. Pérez- Solá ◽

...

Keyword(s):

Primary Care ◽

Clinical Practice ◽

Major Depression ◽

Scientific Evidence ◽

Implementation Process ◽

Clinical Results ◽

Educational Outreach ◽

Active Centers ◽

Active Implementation ◽

Clinical Records

IntroductionThe application of scientific evidence in clinical practice management of Major Depressive Disorder (MDD) is complex. Generally, the usual dissemination process and implementation of Clinical Practice Guidelines (CPG) induce modest changes. A computerized version of a Clinical Practice Guideline for Major Depression (e-CPG-MD) has been integrated in Electronic Clinical Records of Primary Care in Catalonia (Spain). It offers an opportunity to improve clinical results. The design allows access to precise help in the visit itself, improving diagnosis, treatment and follow-up.ObjectivesTo evaluate the effects of a multifaceted implementation process of e-CPG-MD, analysing their use and changes in MDD diagnosis.MethodsA cluster randomized clinical trial was performed in 10 primary care centers (PCC) in Barcelona. In five of ten centers, a multifaceted implementation process of the e-CPG-MD was developed during 6 month. The active process includes: interactive training program, regular feedback audit, educational outreach visits and periodic reminders.ResultsThe multifaceted implementation of e-CPG-MD was associated with a significant increase in use during the first 6 months (4.1% + 3.1% vs. 52.7% + 7.3%, P < 0.001). In the active centers, the MD diagnosis increased significantly (rate quotient = 1.56, P < 0.001) and the proportion of moderate and severe MD increased (13.6% vs 41.1%, P = 0.002).ConclusionsA multifaceted implementation method of e-CPG-MD increased significantly its use in active centers at 6 months. Diagnosis of MDD and the proportion of moderate and severe cases also increased significantly.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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