PROMDEP Randomised controlled trial
Research type
Research Study
Full title
Patient-reported outcome measures for monitoring primary care patients with depression: PROMDEP randomised controlled trial.
IRAS ID
250225
Contact name
Anthony Kendrick
Contact email
Duration of Study in the UK
3 years, 0 months, 0 days
Research summary
Research Summary
The study will look at whether giving personal feedback to people being treated for depression might help them get better more quickly. This will be done by using patient reported outcome measures ('PROMs') which involve patients completing questionnaires to record their symptoms of depression and feeding back these results to the practitioners looking after them. Some benefit for patients has been shown from monitoring progress with PROMs in specialist practice, but this has not been researched in UK general practices where most people with depression are treated.
Engaging and instructive training materials will be provided for GPs using PROMs, indicating specific actions to be taken following assessment. We are using the PHQ-9, a PROM that is acceptable to GPs and identified as useful by them.We will also provide written feedback on PROM results for patients, listing possible treatment options. As patients do not always see the same GP at follow-up as they did at diagnosis, all the GPs in a practice will be trained to follow the same procedures in their appointments with people with depression, to make sure they can stick to what we are asking them to do in the study. We will identify and recruit practices with a track record of recruiting patients with depression, and ensure all the GPs are trained in the study procedures. Rates of following up patients will be maximised through obtaining their permission to text, phone and email them to maintain better contact, more often.
Qualitative interviews will be undertaken with a selection of the participants and the health professionals in the study. This will give us further insight into the acceptability of using the PROMs in this way.
Summary of Results
Depression is common, can be disabling and costs the nation billions. The NHS recommends general practitioners who treat people with depression use symptom questionnaires to help assess whether they are getting better over time. A symptom questionnaire is one type of patient-reported outcome measure (or `PROM’). PROMs appear to benefit people having therapy and mental health care, but this approach has not been tested thoroughly in general practice. Most people with depression are treated in general practice, so it’s important to test PROMs there too.
In this study we tested whether using a PROM helps people with depression get better more quickly. The study was a `randomised controlled trial’ in general practices split into two groups. In one group people with depression completed the Patient Health Questionnaire or `PHQ-9’ PROM, which measures nine symptoms of depression. In the other group people with depression were treated as usual without the PHQ-9. We fed the results of the PHQ-9 back to the people themselves to show them how severe their depression was, and asked them to discuss the results with practitioners looking after them.
We found no differences between the PROM group and control group in their level of depression; their work or social life; satisfaction with care from their practice; or their use of medicines, therapy or specialist care for depression. However, we did find their quality of life improved more over six months, and the costs of the NHS services they used were similar.
Using the PHQ-9 can improve patients’ quality of life, perhaps by making them more aware of improvement in their depression symptoms, and less anxious as a result. Future research should test using a PROM which includes anxiety, and putting the answers through a computer to give practitioners clearer advice on possible changes to treatment for depression.REC name
West of Scotland REC 5
REC reference
18/WS/0144
Date of REC Opinion
22 Aug 2018
REC opinion
Favourable Opinion