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Regular patient centred consultations and continuous use of a self- rating scale; effects on depression and quality of life . A randomized controlled study of structured treatment of mild to moderate depression in primary care. Wikberg C, Björkelund C, Petersson E-L, Westman J, Baigi A.
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Regular patient centred consultations and continuous use of a self-rating scale; effects on depression and quality of life. A randomized controlled study of structured treatment of mild to moderate depression in primary care Wikberg C, Björkelund C, Petersson E-L, Westman J, Baigi A Dept of Public Health and Community Medicine/Section of Primary Health Care, the Sahlgrenska Academy, University of Gothenburg.
Background • Depression is one of the major causes of illness with an estimated prevalence of 10% and causes lowered functional capacity and reduced quality of life. Effects of structured patient centred treatment , and the use of self-rating scales in primary care is not yet properly studied.
Aim • To study effects of regular patient centered consultations with repeated use of self-rating scales on mild-moderate depression in the primary care setting.
Method • GPs are randomized either to control group (treatment as usual) or intervention group. • The study population consists of primary care attendees aged 18 and up with diagnosis of mild to moderate depression (DSM-IV). • Intervention study population is offered frequent patient centred consultations (regular visits 4 times during 12 weeks) with continuous use of self-rating scale MADRS-S to monitor depression course, in addition to treatment as usual. • Control study population gets treatment as usual. • At baseline and after 12 weeks BDI-II and EQ-5D are used to measure depression and QoL in both groups of study population (by a study nurse)
Method GP Randomisation N= 200 Baseline GP Control BDI-II, EQ5D GP Intervention MADRS-S Treatment as usualPLUS 4 weeks MADRS-S Treatment as usual 8 weeks MADRS-S BDI-II, EQ5D MADRS-S GP Control GP Intervention 12 weeks 12 weeks 12 weeks
Resultshalfway… Group 1. Group 2.
Discussion • If the intervention group shows significantly better results on reducing depression and increasing quality of life it can change the way we approach depression treatment – • on the other hand, if no differences can be shown – both managements are good enough...
Takehomemessage. • Trials runs smoother with a research nurse (or other profession) on site.(almost 24/7) • Each site is unique, and requires tailor made solutions in addition to GCP.