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Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial

BACKGROUND: Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. AIM: To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can imp...

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Autores principales: Fletcher, Susan, Chondros, Patty, Densley, Konstancja, Murray, Elizabeth, Dowrick, Christopher, Coe, Amy, Hegarty, Kelsey, Davidson, Sandra, Wachtler, Caroline, Mihalopoulos, Cathrine, Lee, Yong Yi, Chatterton, Mary Lou, Palmer, Victoria J, Gunn, Jane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846356/
https://www.ncbi.nlm.nih.gov/pubmed/33431380
http://dx.doi.org/10.3399/BJGP.2020.0783
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author Fletcher, Susan
Chondros, Patty
Densley, Konstancja
Murray, Elizabeth
Dowrick, Christopher
Coe, Amy
Hegarty, Kelsey
Davidson, Sandra
Wachtler, Caroline
Mihalopoulos, Cathrine
Lee, Yong Yi
Chatterton, Mary Lou
Palmer, Victoria J
Gunn, Jane
author_facet Fletcher, Susan
Chondros, Patty
Densley, Konstancja
Murray, Elizabeth
Dowrick, Christopher
Coe, Amy
Hegarty, Kelsey
Davidson, Sandra
Wachtler, Caroline
Mihalopoulos, Cathrine
Lee, Yong Yi
Chatterton, Mary Lou
Palmer, Victoria J
Gunn, Jane
author_sort Fletcher, Susan
collection PubMed
description BACKGROUND: Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. AIM: To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. DESIGN AND SETTING: Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18–65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care. METHOD: The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months. RESULTS: In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was −0.88 (95% confidence interval [CI] = −1.45 to −0.31) favouring the intervention, and −0.59 at 12 months (95% CI = −1.18 to 0.01); standardised effect sizes of −0.16 (95% CI = −0.26 to −0.05) and −0.10 (95% CI = −0.21 to 0.002), respectively. No serious adverse events were reported. CONCLUSION: Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.
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spelling pubmed-78463562021-02-01 Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial Fletcher, Susan Chondros, Patty Densley, Konstancja Murray, Elizabeth Dowrick, Christopher Coe, Amy Hegarty, Kelsey Davidson, Sandra Wachtler, Caroline Mihalopoulos, Cathrine Lee, Yong Yi Chatterton, Mary Lou Palmer, Victoria J Gunn, Jane Br J Gen Pract Research BACKGROUND: Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. AIM: To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. DESIGN AND SETTING: Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18–65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care. METHOD: The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months. RESULTS: In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was −0.88 (95% confidence interval [CI] = −1.45 to −0.31) favouring the intervention, and −0.59 at 12 months (95% CI = −1.18 to 0.01); standardised effect sizes of −0.16 (95% CI = −0.26 to −0.05) and −0.10 (95% CI = −0.21 to 0.002), respectively. No serious adverse events were reported. CONCLUSION: Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options. Royal College of General Practitioners 2021-01-12 /pmc/articles/PMC7846356/ /pubmed/33431380 http://dx.doi.org/10.3399/BJGP.2020.0783 Text en © The Authors http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
spellingShingle Research
Fletcher, Susan
Chondros, Patty
Densley, Konstancja
Murray, Elizabeth
Dowrick, Christopher
Coe, Amy
Hegarty, Kelsey
Davidson, Sandra
Wachtler, Caroline
Mihalopoulos, Cathrine
Lee, Yong Yi
Chatterton, Mary Lou
Palmer, Victoria J
Gunn, Jane
Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
title Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
title_full Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
title_fullStr Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
title_full_unstemmed Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
title_short Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
title_sort matching depression management to severity prognosis in primary care: results of the target-d randomised controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846356/
https://www.ncbi.nlm.nih.gov/pubmed/33431380
http://dx.doi.org/10.3399/BJGP.2020.0783
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