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

Thompson, Chris; Kinmonth, Ann‐Louise; Stevens, Lesley A.; Peveler, Robert; Stevens, Andrew; Ostler, Kevin; Pickering, Ruth; Baker, Nigel; Henson, Autumn; Preece, Julia; Cooper, Derek; Campbell, Mike

doi:10.1016/s0140-6736(99)03171-2

Cited by 423 publications

(321 citation statements)

References 21 publications

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“…However, a substantial number of important and clinically relevant trials and cohort studies have been published by primary-care based researchers in relation to all the common chronic conditions managed in primary care, including back pain, 18 asthma, 19 cancer, 20 heart failure, 21 diabetes, 22 and depression. 23 Primary care has taken a lead in developing the methodology of applied clinical research to assess the effectiveness of complex health service interventions. 24, 25 There are increasingly influential and important bodies of work being undertaken in relation to the diagnosis, monitoring, and long-term care of illness outside hospital.…”

Section: Primary-care Research Can Affect Clinical Practicementioning

confidence: 99%

The state of primary-care research

et al. 2004

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Section: Primary-care Research Can Affect Clinical Practicementioning

confidence: 99%

The state of primary-care research

et al. 2004

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“…Outcome assessment would involve calculation of the proportion of a target population who successfully negotiate the stages of access to receive appropriate high-quality care, the distribution of care according to need and the effectiveness of that care. Although there are examples in the literature that attempt to apply this design 34,354,355 and methods that might be able to accommodate it, 356 we did not locate any studies that provided a comprehensive assessment of access, equity and effectiveness. It is likely that exploration of these issues will require mixed-methods research combined with enhanced use of routinely collected data from public health and provider sources and creative use of comparators for intervention sites.…”

Section: Discussionmentioning

confidence: 99%

“…32 This model identifies several 'filters' that exist between patients with mental health needs in the community and different 'levels' of care, and has highlighted the importance of the recognition of mental health problems by primary care 'gatekeepers' 33 and the difficulties of training professionals to improve recognition and referral. 34,35 The second major policy concern is the provision of non-pharmacological treatments such as psychological therapies. Although such treatments are generally more acceptable to patients than medication, 36 access is far more restricted because of limitations in the number of adequately trained therapists who can deliver these treatments, and because of problems with cultural congruity between therapists and many prospective clients.…”

Section: Access To Health Carementioning

confidence: 99%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Tiemens et al (1999) implemented a 20-hr training program for primary care physicians on detection, diagnosis, and treatment, finding an initial improvement in short-term outcomes for depressed patients but no effect by 1 year. C. Thompson et al (2000) carried out a randomized, controlled trial of a practice-based educational intervention based on clinical practice guidelines in 60 primary care practices in the United Kingdom and found no effect on either recognition or clinical outcome.…”

Section: Next Wave Of Physician-and Practice-centered Strategies For mentioning

confidence: 99%

Emotional disorders in primary care.

Coyne¹,

Thompson²,

Klinkman³

et al. 2002

Journal of Consulting and Clinical Psychology

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Individuals with emotional disorders are more likely to use primary medical care than specialty mental health services, but these disorders are likely to be undetected or inadequately treated. Recognition of the importance of primary medical care for the treatment of mental disorder has resulted in pressing new research priorities. One set of issues concerns the adequacy of existing nosological systems for conceptualizing emotional disorder in primary care and identifying need for treatment. Another concerns the difficulties translating efficacious treatment into effective strategies that can be integrated into the competing demands of primary medical care. Psychologists have played only a limited role in defining and addressing emerging questions. Irreversible changes in mental health services have created the need for the development of a psychosocial perspective for what would otherwise be defined as narrowly biomedical issues.

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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

Cited by 423 publications

References 21 publications

The state of primary-care research

The state of primary-care research

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Emotional disorders in primary care.

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