Results of the implementation of a Spanish computerized guideline for depression in primary care

Abstract

A new computerized CPG for Major Depression (e-CPG-MD) was integrated in electronic medical records of primary care in a 7 million population in Catalonia (Spain). An integrated design allows precise access in each patient visit, improving diagnosis, treatment and follow-up. It facilitates an evaluation of suicide risk in depressed patients.ObjectiveTo evaluate the effects of a multifactor process of implementation of the e-CPG MD, analyzing its use and the key clinical outcomes.MethodsA cluster randomized clinical trial was performed in 10 primary care centers (PCC) in Barcelona. In five of ten centers a multifaceted implementation process of the e-CPG-MD was developed during 6 month. The others five PCCs received only an usual diffusion. The multifaceted process includes an establishment of local implementation teams, an interactive training program, regular feedback audits, educational outreach visits and periodic reminders.ResultsAt six month, a greater proportion of new MD patients from active PCCs were included in the e- CPG-DEP (4.1% + 3.1% vs. 52.7% + 7.3%, p < 0.001); the incidence of MD diagnostics of Major Depression increased significantly (rate quotient = 1.56, p < 0.001) and the proportion of cases with moderate and severe MD too (13.6% vs 41.1%, p = 0.002).ConclusionsA multifaceted implementation method of an e-CPG-MD increased significantly its uses, the registered incidence of MD and improved the capacity of recognizing severity. Further analysis is necessary in order to determine the impact on clinical outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.