RT Journal Article
SR Electronic
T1 Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP BJGP.2020.0783
DO 10.3399/BJGP.2020.0783
A1 Fletcher, Susan
A1 Chondros, Patty
A1 Densley, Konstancja
A1 Murray, Elizabeth
A1 Dowrick, Christopher
A1 Coe, Amy
A1 Hegarty, Kelsey
A1 Davidson, Sandra
A1 Wachtler, Caroline
A1 Mihalopoulos, Cathrine
A1 Lee, Yong Yi
A1 Chatterton, Mary Lou
A1 Palmer, Victoria J
A1 Gunn, Jane
YR 2020
UL http://bjgp.org/content/early/2021/01/11/BJGP.2020.0783.abstract
AB Background Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required.Aim To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care.Design and setting Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18–65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care.Method The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months.Results In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was −0.88 (95% confidence interval [CI] = −1.45 to −0.31) favouring the intervention, and −0.59 at 12 months (95% CI = −1.18 to 0.01); standardised effect sizes of −0.16 (95% CI = −0.26 to −0.05) and −0.10 (95% CI = −0.21 to 0.002), respectively. No serious adverse events were reported.Conclusion Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.