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Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial

Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial
Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial
Background

Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression.

Methods

We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat.

Findings

The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21?409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1·2 [95% CI 0·88–1·61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve.

Intrepretation

Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.
0140-6736
185-191
Thompson, C.
10784aa4-0fd2-42d4-8c1d-db11eb86e5a2
Kinmonth, A.L
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Stevens, L.
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Peveler, R.C.
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Stevens, A.
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Ostler, K.J.
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Pickering, R.M.
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Baker, N.G.
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Henson, A.
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Preece, J.
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Cooper, D.
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Campbell, M.J.
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Thompson, C.
10784aa4-0fd2-42d4-8c1d-db11eb86e5a2
Kinmonth, A.L
30b36939-1fa9-4853-9d86-8e6be0454106
Stevens, L.
bdd9e5d7-9e63-4a8b-bd5d-82c517b4a78f
Peveler, R.C.
93198224-78d9-4c1f-9c07-fdecfa69cf96
Stevens, A.
ee290275-c6b9-473b-a798-8cc38ee51cb5
Ostler, K.J.
ff6c7603-dda2-4e55-ba2c-f1f8bae30310
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Baker, N.G.
d18a2a84-46a2-402b-8096-f3793a99b299
Henson, A.
43469fb2-818a-4120-8b9a-2619bb87c92b
Preece, J.
f0a44eba-8646-4469-8ad9-eca9edaac11e
Cooper, D.
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Campbell, M.J.
e58c98ae-2fec-4e72-80c2-ae8f0166ba46

Thompson, C., Kinmonth, A.L, Stevens, L., Peveler, R.C., Stevens, A., Ostler, K.J., Pickering, R.M., Baker, N.G., Henson, A., Preece, J., Cooper, D. and Campbell, M.J. (2000) Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. The Lancet, 355 (9199), 185-191. (doi:10.1016/S0140-6736(99)03171-2). (PMID:10675118)

Record type: Article

Abstract

Background

Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression.

Methods

We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat.

Findings

The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21?409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1·2 [95% CI 0·88–1·61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve.

Intrepretation

Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.

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More information

Published date: 15 January 2000
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 361515
URI: http://eprints.soton.ac.uk/id/eprint/361515
ISSN: 0140-6736
PURE UUID: 59dd86fc-dfa1-480f-91d2-358d47dc21f5
ORCID for R.C. Peveler: ORCID iD orcid.org/0000-0001-5596-9394

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Date deposited: 24 Jan 2014 12:48
Last modified: 15 Mar 2024 02:40

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Contributors

Author: C. Thompson
Author: A.L Kinmonth
Author: L. Stevens
Author: R.C. Peveler ORCID iD
Author: A. Stevens
Author: K.J. Ostler
Author: R.M. Pickering
Author: N.G. Baker
Author: A. Henson
Author: J. Preece
Author: D. Cooper
Author: M.J. Campbell

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