Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT Primary care Monitoring for depressive Patients Trial IReport as inadecuate




Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT Primary care Monitoring for depressive Patients Trial I - Download this document for free, or read online. Document in PDF available to download.

BMC Public Health

, 5:101

First Online: 05 October 2005Received: 05 August 2005Accepted: 05 October 2005DOI: 10.1186-1471-2458-5-101

Cite this article as: Gensichen, J., Torge, M., Peitz, M. et al. BMC Public Health 2005 5: 101. doi:10.1186-1471-2458-5-101

Abstract

BackgroundDepression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy in the treatment of depression in highly organized Health Maintenance Organization HMO settings and which might also be effective in other, less structured settings.

Methods-DesignPRoMPT PRimary care Monitoring for depressive Patients Trial is a cluster randomised controlled trial with General Practice GP as the unit of randomisation. The aim of the study is to evaluate a GP applied case-management for patients with major depressive disorder. 70 GPs were randomised either to intervention group or to control group with the control group delivering usual care. Each GP will include 10 patients suffering from major depressive disorder according to the DSM-IV criteria. The intervention group will receive treatment based on standardized guidelines and monthly telephone monitoring from a trained practice nurse. The nurse investigates the patient-s status concerning the MDD criteria, his adherence to GPs prescriptions, possible side effects of medication, and treatment goal attainment. The control group receives usual care – including recommended guidelines. Main outcome measure is the cumulative score of the section depressive disorders PHQ-9 from the German version of the Prime MD Patient Health Questionnaire PHQ-D. Secondary outcome measures are the Beck-Depression-Inventory, self-reported adherence adapted from Moriskey and the SF-36. In addition, data are collected about patients- satisfaction EUROPEP-tool, medication, health care utilization, comorbidity, suicide attempts and days out of work.

The study comprises three assessment times: baseline T0 , follow-up after 6 months T1 and follow-up after 12 months T2.

DiscussionDepression is now recognized as a disorder with a high prevalence in primary care but with insufficient treatment response. Case management seems to be a promising intervention which has the potential to bridge the gap of the usually time-limited and fragmented provision of care. Case management has been proven to be effective in several studies but its application in the private general medical practice setting remains unclear.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-5-101 contains supplementary material, which is available to authorized users.

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Author: Jochen Gensichen - Marion Torge - Monika Peitz - Heike Wendt-Hermainski - Martin Beyer - Thomas Rosemann - Christian Krauth

Source: https://link.springer.com/







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