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A pragmatic cluster randomized controlled trial of an educational intervention for GPs in the assessment and management of depression

Published online by Cambridge University Press:  14 January 2004

L. GASK ,
C. DOWRICK ,
C. DIXON ,
C. SUTTON ,
R. PERRY ,
D. TORGERSON  and
T. USHERWOOD
L. GASK
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
C. DOWRICK
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
C. DIXON
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
C. SUTTON
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
R. PERRY
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
D. TORGERSON
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
T. USHERWOOD
Affiliation:
School of Psychiatry and Behavioural Science, University of Manchester, Department of Primary Care, University of Liverpool; Statistics Group, Department of Physics Astronomy and Mathematics, University of Central Lancashire, Preston and Centre for Health Economics, University of York; and Department of General Practice, University of Sydney at Westmead Hospital, NSW, Australia
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Abstract

Background. General practitioners (GPs) can be provided with effective training in the skills to manage depression. However, it remains uncertain whether such training achieves health gain for their patients.

Method. The study aimed to measure the health gain from training GPs in skills for the assessment and management of depression. The study design was a cluster randomized controlled trial. GP participants were assessed for recognition of psychological disorders, attitudes to depression, prescribing patterns and experience of psychiatry and communication skills training. They were then randomized to receive training at baseline or the end of the study. Patients selected by GPs were assessed at baseline, 3 and 12 months. The primary outcome was depression status, measured by HAM-D. Secondary outcomes were psychiatric symptoms (GHQ-12) quality of life (SF-36), satisfaction with consultations, and health service use and costs.

Results. Thirty-eight GPs were recruited and 36 (95%) completed the study. They selected 318 patients, of whom 189 (59%) were successfully recruited. At 3 months there were no significant differences between intervention and control patients on HAM-D, GHQ-12 or SF-36. At 12 months there was a positive training effect in two domains of the SF-36, but no differences in HAM-D, GHQ-12 or health care costs. Patients reported trained GPs as somewhat better at listening and understanding but not in the other aspects of satisfaction.

Conclusions. Although training programmes may improve GPs' skills in managing depression, this does not appear to translate into health gain for depressed patients or the health service.

Type
Research Article
Information
Psychological Medicine , Volume 34 , Issue 1 , January 2004 , pp. 63 - 72
Copyright
2004 Cambridge University Press

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