Enhanced Collaborative Depression Treatment in Primary Care: The RESPECT-D-E Trial
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Purpose
Primary care physicians have emerged as the predominant mental health care providers for diagnosing and treating depression. The majority of patients with mood disorders receive treatment in the primary care setting, within which approximately 10-30% of all patients present with a depressive disorder. Comprehensive 'Collaborative Care' models of depression management significantly improve depression outcomes and health-related quality of life. Core features of these programs include use of a trained depression care manager to closely coordinate with primary care clinicians, support treatment recommendations, provide patient education, conduct patient follow-up to ensure adequate treatment, and manage as-needed access to psychiatrists for patients with more complex presentations. Evidence based Collaborative Care models do not currently weave in the use of web-based or mobile technologies. These technologies offer unique features that may make collaborative depression care more effective. The digital health coaching program for depressive symptoms enhanced during Phase I of the current project is a web-based tool featuring video, text, links and graphics which provide patients with education, self-management techniques, tailored feedback, and tools for tracking treatment progress. The RESPECT-D (Re-engineering Systems of Primary Care Treatment of Depression) intervention is a collaborative depression management model for primary care. The primary objective of this project is to compare the efficacy of an enhanced Collaborative Care model for depression (RESPECT-D-E) to the standard model (RESPECT-D) for patients with minor and major depression and dysthymic disorder. This study will be a randomized controlled trial with 150 participants who are receiving antidepressant medication treatment in the primary care setting. The primary objectives are: reduction in subject reported depressive symptoms, improvement in subject reported health related quality of life and improvement in subject adherence to treatment regimen as demonstrated by self-report measures and clinician-administered assessment. The investigators hypothesize that compared to RESPECT-D at 12 weeks, participants randomized to RESPECT-D-E will demonstrate: a greater reduction in depressive symptoms, a greater improvement in health-related quality of life and a greater satisfaction with quality of depression care received.
| Condition | Intervention |
|---|---|
|
Depressive Disorder, Major Depressive Disorder, Minor Dysthymic Disorder |
Other: RESPECT-D Other: RESPECT-D-E (Enhanced) |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | Development and Evaluation of Enhanced Digital Health Coaching Program for Depressive Symptoms to Support Collaborative Depression Treatment in Primary Care: The RESPECT-D-E (Enhanced) Trial |
- Change in Score of Hamilton Rating Scale for Depression (HAM-D) [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]17-item assessment rated during a clinical interview
- Change in Score of Hopkins Symptom Checklist-20 (HSCL-20) [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]Self-report measure of depressive symptom severity
| Estimated Enrollment: | 150 |
| Study Start Date: | September 2011 |
| Estimated Study Completion Date: | December 2013 |
| Estimated Primary Completion Date: | September 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: RESPECT-D
The RESPECT-D Model: Collaborative Care depression treatment within primary care including care manager
|
Other: RESPECT-D
The RESPECT-D (Re-engineering Systems of Primary Care Treatment of Depression) intervention is a systematic approach to the assessment and management of depression within Primary Care. The essential components of the Collaborative Care model include prepared PCPs and practices, the Care Manager, and a Behavioral Health specialist all working in partnership with the patient. The trained depression care manager closely coordinates with primary care clinicians, supports treatment recommendations, patient education, appropriate follow-up to ensure adequate treatment, and coordination with a consulting psychiatrist.
Other Name: Collaborative Care Treatment for Depression in Primary Care
|
|
Experimental: RESPECT-D-E
RESPECT-D-E: Collaborative Care depression treatment within primary care including care manager plus on-line coaching, education and symptom, side effect and, medication adherence tracking with the digital health coaching program for depressive symptoms.
|
Other: RESPECT-D-E (Enhanced)
The RESPECT-D-E intervention includes all of the components of the RESPECT-D model, but also incorporates the enhanced digital health coaching program for depressive symptoms tool, is an on-line program with education, coaching, self-management techniques, symptom, side effect and medication adherence tracking for depression. Depressive symptoms, medication side effects and adherence data are automatically delivered to the Care Manager for use in treatment planning. The program provides tailored feedback, provides coaching on skills related to depression treatment (such as changing negative thoughts and avoiding relapse), and offers tools for tracking behavior change.
Other Names:
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Show Detailed Description Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Males and Females, ages 18 and older who are self-reporting generally good health.
- Newly started on an antidepressant medication, switched to a different antidepressant medication or prescribed an increased dosage of antidepressant medication within the past 2 weeks.
- A Hamilton Depression Rating Scale (HAM-D) score of greater than 10.
- A Patient Health Questionnaire (PHQ-9) score of 10 or greater, with endorsement of depressed mood or anhedonia, and endorsement of impaired daily function.
- Meets diagnostic criteria for Major Depressive Disorder, persistent Minor Depressive Disorder (i.e., > 1 month duration), or Dysthymic Disorder via a structured interview with the PRIME-MD.
- Able to read, understand, and sign the Informed Consent in English.
- Willing and able to comply with study requirements.
- Well-versed in using a personal computer and the internet and must have easy access to a computer connected to the internet everyday (both weekdays and weekends).
- Enrollment in Surescripts Pharmacy benefit plan
- Currently under care with a Provider in Family Medicine at Cheshire Medical Center / Dartmouth-Hitchcock Keene
Exclusion Criteria:
- Subjects must not have a major psychiatric co-morbid condition (schizophrenia, bipolar affective disorder, obsessive-compulsive disorder, PTSD, or a depressive disorder with psychotic features, as determined from chart review and patient report).
- Subjects must not have a substance use disorder or dependence as assessed by: CAGE Alcohol Dependence Questionnaire score >3
- Subjects must not have a history of treatment -resistant depression as defined by the following: Psychiatric hospitalization within the past year; More than 2 clinically ineffective antidepressant medication trials, of adequate duration and adequate dose, within the current depressive episode; Any history of Electroconvulsive Therapy (ECT); A trial of Monoamine Oxidase inhibitor (MAO) within the past year.
- Subjects must not report being actively suicidal
- Subjects must score 4 or greater on the Callahan Six-Item Cognitive Screening assessment
- Subjects must not be diagnosed with a terminal or near terminal medical illness such that their primary care provider has estimated the patient has less than 6 months to live.
- Subjects reporting any medical condition that would make it unsafe to participate in a research study.
- Participation in any other clinical research study within the past 30 days.
- Participation in any on-line depression-related coaching or lifestyle improvement program within the past 5 years.
Contacts and Locations| Contact: Emily J Geiger | (603) 650-4536 | emily.j.geiger@dartmouth.edu |
| United States, New Hampshire | |
| Family Medicine Clinics, Cheshire Medical Center (DH-Keene) | Recruiting |
| Keene, New Hampshire, United States, 03431 | |
| Contact: Emily Geiger 603-650-4536 emily.j.geiger@dartmouth.edu | |
| Principal Investigator: Mark T Hegel, PhD | |
| Principal Investigator: | Mark T. Hegel, PhD | Dartmouth-Hitchcock Medical Center |
More Information
Publications:
| Responsible Party: | Mark T. Hegel, Associate Professor, Dartmouth-Hitchcock Medical Center |
| ClinicalTrials.gov Identifier: | NCT01583400 History of Changes |
| Other Study ID Numbers: | CPHS#22616, W&P-PCMH-01 |
| Study First Received: | April 12, 2012 |
| Last Updated: | February 14, 2013 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Dartmouth-Hitchcock Medical Center:
|
Depressive Disorder, Major Depressive Disorder, Minor Dysthymic Disorder |
Additional relevant MeSH terms:
|
Depression Depressive Disorder Dysthymic Disorder Depressive Disorder, Major |
Behavioral Symptoms Mood Disorders Mental Disorders |
ClinicalTrials.gov processed this record on June 13, 2013