Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial.



Fletcher, Susan, Chondros, Patty, Densley, Konstancja, Murray, Elizabeth, Dowrick, Christopher, Coe, Amy, Hegarty, Kelsey, Davidson, Sandra, Wachtler, Caroline, Mihalopoulos, Cathrine
et al (show 4 more authors) (2021) Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial. The British journal of general practice : the journal of the Royal College of General Practitioners, 71 (703). e85 - e94.

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Abstract

<h4>Background</h4>Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required.<h4>Aim</h4>To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care.<h4>Design and setting</h4>Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18-65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care.<h4>Method</h4>The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months.<h4>Results</h4>In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was -0.88 (95% confidence interval [CI] = -1.45 to -0.31) favouring the intervention, and -0.59 at 12 months (95% CI = -1.18 to 0.01); standardised effect sizes of -0.16 (95% CI = -0.26 to -0.05) and -0.10 (95% CI = -0.21 to 0.002), respectively. No serious adverse events were reported.<h4>Conclusion</h4>Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.

Item Type: Article
Uncontrolled Keywords: Humans, Prognosis, Treatment Outcome, Depression, Quality of Life, Adolescent, Adult, Aged, Middle Aged, Primary Health Care, Australia, Young Adult
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 20 Jul 2021 09:36
Last Modified: 10 Oct 2021 03:10
DOI: 10.3399/bjgp.2020.0783
Open Access URL: https://doi.org/10.3399/BJGP.2020.0783
URI: https://livrepository.liverpool.ac.uk/id/eprint/3130695