A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care: protocol for a cluster randomized controlled trial

Graciela Rojas,Pablo Martínez,Ricardo Araya,Solange Campos,Pablo Herrera,Wilsa Szabo,Víctor Gómez,Paul A Vöhringer,Viviana Guajardo

doi:10.1186/s12888-021-03380-2

Abstract

BackgroundDepression and chronic diseases are frequently comorbid public health problems. However, clinical guidelines often fail to consider comorbidities. This study protocol describes a cluster randomized trial (CRT) aimed to compare the effectiveness of a collaborative, computer-assisted, psycho-educational intervention versus enhanced usual care (EUC) in the treatment of depressed patients with hypertension and/or diabetes in primary care clinics (PCC) in Santiago, Chile.MethodsTwo-arm, single-blind, CRT carried out at two municipalities in Santiago, Chile. Eight PCC will be randomly assigned (1:1 ratio within each municipality, 4 PCC in each municipality) to the INTERVENTION or EUC. A total of 360 depressed patients, aged at least 18 years, with Patient Health Questionnaire-9 Item [PHQ-9] scores ≥15, and enrolled in the Cardiovascular Health Program at the participating PCC. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and resident in long-term care facilities, will be excluded. Patients in both arms will be invited to use the Web page of the project, which includes basic health education information. Patients in the INTERVENTION will receive eight sessions of a computer-assisted, psycho-educational intervention delivered by trained therapists, a structured telephone calls to monitor progress, and usual medical care for chronic diseases. Therapists will receive biweekly and monthly supervision by psychologist and psychiatrist, respectively. A monthly meeting will be held between the PCC team and a member of the research team to ensure continuity of care. Patients in EUC will receive depression treatment according to clinical guidelines and usual medical care for chronic diseases. Outcome assessments will be conducted at 3, 6, and 12 months after enrollment. The primary outcome will be depression improvement at 6 months, defined as ≥50% reduction in baseline PHQ-9 scores. Intention-to-treat analyses will be performed.DiscussionThis study will be one of the first to provide evidence for the effectiveness of a collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care in a Latin American country.Trial registrationretrospectively registered in ClinicalTrials.gov, first posted: November 3, 2020, under identifier: NCT04613076.

Highlights

Depression and chronic diseases are frequently comorbid public health problems
Studies have revealed that depression comorbid with medical conditions is the rule rather than the exception, as up to two thirds of the depressed subjects were diagnosed with physical health comorbidities in a Scottish country-wide primary care study [5], with the disease cluster of cardio-metabolic conditions and depression being one of the most common multimorbidity patterns throughout clinical settings according to a systematic review [6]
To compare the proportion of patients recovered from depression treated with the “Me cuido y me siento mejor” intervention versus enhanced usual care in primary care clinics

Summary

Introduction

Depression and chronic diseases are frequently comorbid public health problems. clinical guidelines often fail to consider comorbidities. Population ageing means that cardiovascular diseases and diabetes are becoming more prevalent, while depression might further limit the capacities of this ever increasing older workforce [3, 4]. Studies have revealed that depression comorbid with medical conditions is the rule rather than the exception, as up to two thirds of the depressed subjects were diagnosed with physical health comorbidities in a Scottish country-wide primary care study [5], with the disease cluster of cardio-metabolic conditions and depression being one of the most common multimorbidity patterns throughout clinical settings according to a systematic review [6]. Endorsement of the statement “no health without mental health” should readily translate into evidence-based clinical practice guidelines that consider physical and mental health comorbidities [12]

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