Effectiveness of clinical decision support systems and telemedicine on outcomes of depression: a cluster randomized trial in general practice.

Decision Support Systems, Clinical Depression / therapy General Practice Humans Quality of Life Telemedicine
Computerized Clinical Decision Support Systems depression patient–doctor relationship primary care quality of life telemedicine

Journal

Family practice
ISSN: 1460-2229
Titre abrégé: Fam Pract
Pays: England
ID NLM: 8500875

Informations de publication

Date de publication:
28 11 2020
Historique:
pubmed: 9 8 2020
medline: 26 10 2021
entrez: 9 8 2020
Statut: ppublish

Résumé

Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies. Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care. This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring ≥11 on Patient Heath Questionnaire and ≥26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview. Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, χ 2 = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview. Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression. The trial was registered on https://clinicaltrials.gov/ on 5 October 2012 with identifier: NCT01701791. The first participant was enrolled on 5 May 2014 and the study was completed on May 2016.

Sections du résumé

BACKGROUND
Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies.
OBJECTIVES
Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care.
METHODS
This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring ≥11 on Patient Heath Questionnaire and ≥26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview.
RESULTS
Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, χ 2 = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview.
CONCLUSIONS
Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression.
TRIAL REGISTRATION
The trial was registered on https://clinicaltrials.gov/ on 5 October 2012 with identifier: NCT01701791. The first participant was enrolled on 5 May 2014 and the study was completed on May 2016.

Identifiants

DOI: 10.1093/fampra/cmaa077 PMID: 32766705
pubmed: 32766705
pii: 5882119
doi: 10.1093/fampra/cmaa077
doi:

Banques de données

ClinicalTrials.gov
['NCT01701791']

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

731-737

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Auteurs

Matteo Balestrieri (M)

Unit of Psychiatry, DAME, University of Udine, Udine, Italy.

Davide Sisti (D)

Department of Biomolecular Sciences-Unit of Medical Statistic and Biometry, University of Urbino 'Carlo Bo', Urbino, Italy.

Marco Rocchi (M)

Department of Biomolecular Sciences-Unit of Medical Statistic and Biometry, University of Urbino 'Carlo Bo', Urbino, Italy.

Paola Rucci (P)

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.

Gregory Simon (G)

Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.

Ricardo Araya (R)

Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London.
Centre for Global Mental Health and Primary Care Research, Health Service and Population Research (PO36), IoPPN, David Goldberg Centre, King's College London, London, UK.

Giovanni de Girolamo (G)

Unit of Psychiatric Epidemiology and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.

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Classifications MeSH

questionsmedicales.fr › Sciences de l'information › Informatique › Informatique médicale › Applications de l'informatique médicale › Systèmes d'information › Systèmes d'aide à la décision clinique › Effectiveness of clinical decision support...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Dépression › Effectiveness of clinical decision support...
questionsmedicales.fr › Professions de santé › Médecine › Médecine générale › Effectiveness of clinical decision support...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Effectiveness of clinical decision support...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Effectiveness of clinical decision support...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Télémédecine › Effectiveness of clinical decision support...