Abstract
BackgroundThe World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities. Although there is a high prevalence of multimorbidity, health care systems are mainly designed for the management of individual diseases. Given the difficulty in delivering face-to-face psychological treatments, alternative models of treatment delivery have been proposed, emphasizing the role of technologies such as the Internet. The aim of this study is to assess the efficacy in Primary Care (PC) of a blended low-intensity psychological intervention applied using information and communication technologies (ICTs) for the treatment of multimorbidity in PC (depression and type 2 diabetes/low back pain) by means of a randomized controlled trial (RCT). Our main hypothesis is that improved usual care combined with psychological therapy applied using ICTs will be more efficacious for improvement in the symptomatology of multimorbidity, compared to a group with only improved treatment as usual six months after the end of treatment.MethodsA protocol has been designed combining a face-to-face intervention with a supporting online programme that will be tested by an RCT conducted in three different regions (Andalusia, Aragon and the Balearic Islands). The RCT will evaluate three hundred participants diagnosed with depression and type 2 diabetes/low back pain. Four highly experienced research groups specializing in clinical psychology are involved in this trial, and there will be ample possibilities for translation and transfer to usual clinical practice.DiscussionThis clinical trial will lead to improvement in financial sustainability, maximizing the use of resources and responding to principles of efficiency and effectiveness. Furthermore, based on the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. In conclusion, positive results of this study could have a significant impact on one of the most important health-related problems, multimorbidity.Trial registrationClinicalTrials.gov, NCT03426709. Registered retrospectively on 08 February 2018.
Highlights
The World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities
The only meta-analysis to look at the efficacy of comorbidity treatment analysed 9 randomized controlled trials (RCTs), most of them in elderly patients [2]
Forms of personalized intervention based on ‘stepped care’ models and using Information and communication technologies (ICTs) have not been evaluated in multimorbidity
Summary
The World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities. There is a high prevalence of multimorbidity, health care systems are mainly designed for the management of individual diseases. The aim of this study is to assess the efficacy in Primary Care (PC) of a blended low-intensity psychological intervention applied using information and communication technologies (ICTs) for the treatment of multimorbidity in PC (depression and type 2 diabetes/low back pain) by means of a randomized controlled trial (RCT). The structure of health systems and those of medical research and education is designed for the prevention, treatment and management of isolated diseases and not multimorbidity. The only meta-analysis to look at the efficacy of comorbidity treatment analysed 9 randomized controlled trials (RCTs), most of them in elderly patients [2]. The interventions consisted of a change in the provision of care (case management or interdisciplinary collaboration) or patient-oriented interventions. Forms of personalized intervention based on ‘stepped care’ models and using ICTs have not been evaluated in multimorbidity
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