Improving the detection and management of depression in primary care

Gilbody, Simon; Whitty, Paula; Grimshaw, Jeremy; Thomas, Ruth

doi:10.1136/qhc.12.2.149

Cited by 101 publications

(83 citation statements)

References 76 publications

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“…Finally, one study used the general practitioner's diagnosis of depression [10]. It has been reported that depressive symptoms are not recognised in about half of attending patients with depressive disorders in UK general practice [23] and this under-recognition of depression would result in underestimation of the effect size between depression and onset of diabetes. Therefore, we performed a sensitivity analysis excluding this study, which resulted in a slightly higher pooled relative risk: 1.44 (1.21-1.71).…”

Section: Discussionmentioning

confidence: 99%

Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis

et al. 2006

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Aims/hypothesis: Evidence strongly suggests that depression and type 2 diabetes are associated, but the direction of the association is still unclear. Depression may occur as a consequence of having diabetes, but may also be a risk factor for the onset of type 2 diabetes. This study examined the latter association by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic. Methods: Medline and PsycInfo were searched for articles published up to January 2005. All studies that examined the relationship between depression and the onset of type 2 diabetes were included. Pooled relative risks were calculated using fixed and random effects models. To explore sources of heterogeneity between studies, subgroup analyses and meta-regression analyses were performed. Results: Nine studies met our inclusion criteria for this meta-analysis. The pooled relative risk was 1.26 (1.13-1.39) using the fixed effects model and 1.37(1.14-1.63) using the random effects model. Heterogeneity between studies could not be explained by (1) whether studies controlled for undetected diabetes at baseline; (2) the method of diabetes assessment at followup; (3) the baseline overall risk of diabetes in the study population; and (4) follow-up duration. Conclusions/ interpretation: Depressed adults have a 37% increased risk of developing type 2 diabetes mellitus. The pathophysiological mechanisms underlying this relationship are still unclear and warrant further research. A randomised controlled study is needed to test whether effective prevention or treatment of depression can reduce the incidence of type 2 diabetes and its health consequences.

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Section: Discussionmentioning

confidence: 99%

Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis

et al. 2006

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“…Consiste en la dis posición de los recursos en niveles de aten ción en función de la gravedad y evolución de los trastornos depresivos. En general es evaluado como parte de otras propuestas colaborativas más complejas 7,22,61 . El mode lo se corresponde con las recomendaciones de la GPC del National Institute for Health and Care Excellence (NICE) 77 , pero su organización concreta y el tipo de asisten cia varían según los sistemas sanitarios 3,78 .…”

Section: Tabla 2 Evaluación De La Calidad De Las Revisionesunclassified

“…La evidencia sobre su efectividad es limita da. Se sugiere que su integración en mode los más complejos de atención colaborativa podría asociarse con mejores resultados 77 , mayor concordancia con la medicación y mejora en las tasas de recuperación 22 .…”

Section: Tabla 2 Evaluación De La Calidad De Las Revisionesunclassified

“…Se enfoca a la vincula ciónderivación entre los profesionales de AP y SM con especial atención al compo nente formativo 22,79,80 . La responsabilidad en el seguimiento de los pacientes se man tiene principalmente en AP 68,81 , aunque su práctica varía según las condiciones de acceso, cobertura y organización de los ser vicios de salud 45,63,81 .…”

Section: Tabla 2 Evaluación De La Calidad De Las Revisionesunclassified

“…De ahí que su efectividad se reconozca condicionada por los contextos 32,43,52 y plazos temporales 22,38 en que se han llevado a cabo, con gran hete rogeneidad de experiencias y ámbitos de aplicación e importantes inversiones de tiempo y recursos 86,87 . Algunos estudios muestran mejoras a los 6 meses y en algún caso hasta los 5 años 38,43 , mientras que en otros los resultados favorables se eviden cian a los 12 meses para desaparecer a los 2 años 22 .…”

Section: Programas De Mejora De Calidad Y Breakthrough Series Los Deunclassified

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Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática

Gómez

Mosquera

Gea

et al. 2014

Rev. Esp. Salud Publica

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RESUMENFundamentos: Las carencias en la colaboración entre Atención Primaria (AP) y Salud Mental (SM) constituyen un problema relevante en la atención a los pacientes con depresión. Resulta necesario analizar y evaluar los mode los de colaboración existentes para valorar su aplicabilidad en el sistema de salud español. El objetivo del presente estudio es conocer las principales ca racterísticas de los distintos modelos de colaboración APSM en la atención a los pacientes diagnosticados de depresión y la calidad de la evidencia cientí fica acerca de su efectividad.Métodos: Metarevisión sistemática de los estudios secundarios publi cados entre 2001 y 2010 en MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME y la Biblioteca Cochrane. Las revisiones se evaluaron mediante la herramienta AMSTAR. Se realizó una síntesis aproximativa de la calidad de las evidencias encontradas.Resultados: Se evaluaron 69 estudios. La variabilidad según contextos y las carencias metodológicas condicionan que la calidad de las evidencias sea en general baja o dudosa. Las estrategias más efectivas integran intervencio nes de responsabilización en el seguimiento de los pacientes, rediseños en la gestión, e información y comunicación compartidas. Las metarevisiones de estudios secundarios sobre modelos colaborativos favorecen la accesibilidad a las evidencias publicadas, pero conllevan importantes retos metodológicos.Conclusiones: La calidad de la evidencia sobre la efectividad de los mo delos de colaboración APSM durante la atención sanitaria a las personas con depresión es predominantemente baja o dudosa y su significado y aplicabili dad son menores cuanto más se simplifica el análisis de sus componentes, procesos y circunstancias de implementación.

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Shared Decision Making for Antidepressants in Primary Care

et al. 2015

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IMPORTANCE For antidepressants, the translation of evidence of comparative effectiveness into practice is suboptimal. This deficit directly affects outcomes and quality of care for patients with depression. To overcome this problem, we developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians consider the available antidepressants and the extent to which they improved depression and other issues important to patients. OBJECTIVE Estimate the effect of DMC on quality of the decision-making process and depression outcomes. DESIGN, SETTING, AND PARTICIPANTS We conducted a cluster randomized trial of adults with moderate to severe depression considering treatment with an antidepressant. Primary care practices in 10 rural, suburban, and urban primary care practices across Minnesota and Wisconsin were randomly allocated to treatment of depression with or without use of the DMC decision aid. INTERVENTION Depression Medication Choice, a series of cards, each highlighting the effect of the available options on an issue of importance to patients for use during face-to-face consultations. MAIN OUTCOMES AND MEASURES Decision-making quality as judged by patient knowledge and involvement in decision making, patient and clinician decisional comfort (Decisional Conflict Scale) and satisfaction, encounter duration, medication adherence, depression symptoms, and the Patient Health Questionnaire for depression (PHQ-9). RESULTS We enrolled 117 clinicians and 301 patients (67% women; mean [SD] age, 44 [15] years; mean [SD] PHQ-9 score, 15 [4]) into the trial. Compared with usual care (UC), use of DMC significantly improved patients' decisional comfort (DMC, 80% vs UC, 75%; P = .02), knowledge (DMC, 65% vs UC, 56%; P = .03), satisfaction (risk ratio [RR], from 1.25 [P = .81] to RR, 2.4 [P = .002] depending on satisfaction domain), and involvement (DMC, 47% vs UC, 33%; P<.001). It also improved clinicians' decisional comfort (DMC, 80% vs UC, 68%; P < .001) and satisfaction (RR, 1.64; P = .02). There were no differences in encounter duration, medication adherence, or improvement of depression control between arms. CONCLUSIONS AND RELEVANCE The DMC decision aid helped primary care clinicians and patients with moderate to severe depression select antidepressants together, improving the decision-making process without extending the visit. On the other hand, DMC had no discernible effect on medication adherence or depression outcomes. By translating comparative effectiveness into patient-centered care, use of DMC improved the quality of primary care for patients with depression. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01502891

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Improving the detection and management of depression in primary care

Cited by 101 publications

References 76 publications

Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis

Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática

Shared Decision Making for Antidepressants in Primary Care

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