Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America

Abstract

Introduction Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. Materials and methods Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. Results 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. Conclusions Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.

Application of the Delphi Method in the Study of Depressive Disorder

“…However, even if a patient is fully on-target for a drug, there is still a chance that the drug will not work well ( 41 , 42 ). Selective serotonin reuptake inhibitors (SSRIs) are often recommended as the antidepressant of choice ( 43 ), but 30–40% of patients do not respond adequately to the first prescribed antidepressant ( 44 ), this may be due to the patient’s genotype insensitive to SSRIs. Oestergaard et al ( 45 ) conducted a Delphi study on whether 5-HTTLPR polymorphism screening should be used in clinical problems of depression, expert opinion pointed out the impact of 5-HTTLPR pre-detection on clinical outcomes, the introduction of 5-HTTLPR genotyping will lead to 33.8, 48.2, 57.8, and 65.1% of patients reaching remission at 1, 2, 3, and 6 months, respectively.…”

Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America

“…Previous evidence suggests that tailored interventions are more likely to have positive impact compared to generic approaches [ 43–46 ], and confirms the importance of involving community stakeholders in the development and delivery of alcohol prevention programmes [ 92 , 93 ]. Interim results from the wider SCALA study suggest that the tailored training package implemented in our intervention municipalities has led to increased coverage of alcohol measurement, and in turn depression screening, amongst PHC patients [ 80 , 94 ].…”

Costs of an Alcohol Measurement Intervention in Three Latin American Countries

“…Specifically, the following implementation strategies are included in the SCALA study: (1) provision of standard training combined with standard clinical package, e.g., clinical pathway and support materials (henceforth: standard training and clinical package); (2) provision of a more intensive training combined with a longer clinical package (henceforth: intensive training and clinical package); and (3) provision of community support. The strategies were compared to a control group, i.e., care as usual [ 22 , 23 ]. In each of the three participating countries, two municipalities were recruited (one without community support, and one with community support, see Table A1 for more information), each with 9–10 participating PHC centres (PHCC).…”