Abstract
BackgroundPrimary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice.MethodsObjective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care.Design: A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system.Participants: The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia).Intervention: The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework.Measures: Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact.DiscussionThis project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society.Trial registrationClinicalTrials.gov identifier: NCT03285659; Registered 12th September, 2017.
Highlights
Primary care is the principal clinical setting for the management of depression
We aim to develop an effective strategy for implementing and generalizing the Interventions for Depression Improvement (INDI) model for depression management in the primary care context of the Catalan public healthcare system that is practical, effective, acceptable and perceived as useful by patients, healthcare professionals, and the organization
There will be a minimum of two focus groups for each professional tier – primary care physicians and nurses – and they will continue until enough information is obtained
Summary
Primary care is the principal clinical setting for the management of depression. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Major depression is a highly prevalent disorder. The ESEMED study found the lifetime prevalence of major depressive disorder to be 10.6% in Spain, and 12-month prevalence to be 4% [1]. The most common mental health disorders, including depression, are managed in a primary care context [4]. A study conducted in primary care centers in Catalonia found that 14% of consecutive patients seen for any reason met criteria for major depression [5], and there is general consensus that the level of care at which depression can be managed most adequately and efficiently is primary care, in both developing and developed countries [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
