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Patient-reported outcome measures for monitoring primary care patients with depression: PROMDEP feasibility randomised trial

Kendrick, T; Stuart, B; Leydon, GM; Geraghty, AWA; Yao, L; Ryves, R; Williams, S; ... Moore, M; + view all (2017) Patient-reported outcome measures for monitoring primary care patients with depression: PROMDEP feasibility randomised trial. BMJ Open , 7 (3) , Article e015266. 10.1136/bmjopen-2016-015266. Green open access

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Abstract

Objectives To determine the feasibility of a trial of patient-reported outcome measures (PROMs) for monitoring primary care patients with depression. Design Partly individually randomised, partly cluster-randomised controlled trial. Setting Nine general practices in Southern England. Participants 47 adults with new episodes of depression: 22 intervention, 25 control. Randomisation Remote computerised sequence generation and allocation. Interventions Patient Health Questionnaire, Distress Thermometer Analogue Scale and PSYCHLOPS problem profile for monitoring depression, following diagnosis and at 10–35 days later. Feedback of scores to patients was determined by practitioners. Blinding Non-blinded, using self-completed measures. Primary outcome Beck Depression Inventory (BDI-II). Secondary outcome measures Work and Social Adjustment Scale (WSAS), EuroQol Five-item, Five-level (EQ-5D-5L) Scale for quality of life, modified Client Service Receipt Inventory for costs, Medical Informant Satisfaction Scale (MISS), qualitative interviews with 14 patients and 13 practice staff about feasibility and acceptability of trial design. Results Three practices failed to recruit the target of six patients in 12 months. Follow-up rates were intervention patients: 18 (82%) at 12 weeks and 15 (68%) at 26 weeks; controls: 18 (72%) and 15 (60%), respectively. At 12 weeks, mean BDI-II score was lower among intervention group patients than controls by 5.8 points (95% CI −11.1 to −0.5), adjusted for baseline differences and clustering. WSAS scores were not significantly different. At 26 weeks, there were no significant differences in symptoms, social functioning, quality of life or costs, but mean satisfaction score was higher among controls by 22.0 points (95% CI −40.7 to −3.29). Intervention patients liked completing PROMs, but were disappointed when practitioners did not use the results to inform management. Conclusions PROMs may improve depression outcome in the short term, even if PROM scores do not inform practitioners' management. Challenges in recruiting and following up patients need addressing for a definitive trial of relatively brief measures which can potentially inform management. Trial registration number ISRCTN 97492541; Pre-results.

Type: Article
Title: Patient-reported outcome measures for monitoring primary care patients with depression: PROMDEP feasibility randomised trial
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2016-015266
Publisher version: http://doi.org/10.1136/bmjopen-2016-015266
Language: English
Additional information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, Clinical-outcomes, General-practice, Treatment Comet, UK Quality, Severity, Project, Anxiety, Scale, PHQ-9
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1550480
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