Targeted education for general practitioners reduces risk of depression or suicide ideation or attempts in older primary care patients



Maxwell M (2013) Targeted education for general practitioners reduces risk of depression or suicide ideation or attempts in older primary care patients. Evidence-Based Mental Health, 16 (1), pp. 8-8.

Question: Can a targeted educational intervention for general practitioners (GPs) reduce the 2-year prevalence of depression and self-harm among older patients?Population: 373 Australian GPs and 21 762 patients aged 60 years or older (mean age 71.8 years).Setting: General practices in Australia; June 2005-June 2008.Intervention: Practice audit with personalised automated audit feedback and educational material (intervention) versus audit with no personalised feedback (control). The audit was of 20 consecutive older patients attending the practice, who filled in a questionnaire including the nine-item Patient Health Questionnaire (PHQ-9) and the Depressive Symptom Index Suicidality Scale. GPs were asked to fill out questionnaires about these patients, including the likelihood of their being depressed and suicide risk. Feedback was given to the intervention group GPs on the number of patients with depression in their practice compared with other practices, the number of patients with depression and self-harm ideation that they correctly identified, and information about the patients with self-reported symptoms of depression. GPs assigned to the intervention also received printed educational material and 6-monthly educational newsletters for 24 months, and were directed to relevant sections of the materials based on the results of the audit. The education materials provided information about screening, diagnosis and management of depression and suicide behaviour in later life. GPs at control practices received feedback only on pooled data and a newsletter detailing progress of the study. Outcomes: Composite outcome of self-reported clinically significant depression (PHQ-9 score ≥10) or self-harm behaviour (self-reported suicide ideation or attempt during the previous year) at 12 and 24 months after recruitment. Analyses were adjusted for baseline depressive and self-harm behaviour, and potential confounders. Patient follow-up: 88% of patients and 99.7% of GPs completed the study; 97% of patients in the intervention group were included in intention-to-treat analyses and 91% of those in the control group.METHODS: Design: Cluster randomised controlled trial. Allocation: Concealed. Blinding: Unblinded. Follow-up period: 24 months.MAIN RESULTS: The personalised feedback and educational intervention reduced the proportion of older patients experiencing depression or suicide ideation or attempt during follow-up compared with control (absolute risk 10.4% with intervention vs 11.4% with control; adjusted OR 0.90, 95% CI 0.83 to 0.97). When the outcomes were examined separately, the intervention had no effect on depression (AR 8.1% with intervention vs 8.7% with control; adjusted OR 0.93, 95% CI 0.83 to 1.03), but it did reduce the risk of suicide ideation or attempt compared with control (AR 4.5% with intervention vs 5.1% with control; adjusted OR 0.80, 95% CI 0.68 to 0.94). Secondary analyses suggested that the differences seen were not due to differences in the numbers of patients receiving antidepressants, contact with mental health professionals or other types of support between the groups.CONCLUSIONS: Practice audit and targeted education for GPs reduced the composite 2-year risk of depression or suicide ideation or attempt in older patients.NOTES: GPs were randomised in blocks of 24 doctors. GPs working at the same practice were assigned to the same group, to reduce the risk of contamination. Patients who died during the study were excluded from analyses.

Evidence-Based Mental Health: Volume 16, Issue 1

Publication date28/02/2013
PublisherBMJ Publishing Group

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Professor Margaret Maxwell

Professor Margaret Maxwell

Professor, NMAHP