Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial

Background Depression is a major individual and public-health burden throug hout the world and is managed mainly in primary care. The most effective st rategy to reduce this burden has been believed to be education of primary-c are practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in impr oving the recognition and outcome of primary-care depression. Methods We carried out a randomised controlled trial in a representative sa mple of 60 primary-care practices (26% of the total) in an English health d istrict. Education was delivered to practice teams and quality tested by fe edback from participants and expert raters, The primary endpoints were reco gnition of depression, defined by the hospital anxiety and depression (HAD) scale, and improvement. Analysis was by intention to treat. Findings The education was well received by participants, 80% of whom thoug ht it would change their management of patients with depression. 21 409 pat ients were screened, of whom 4192 were classified as depressed by the HAD s cale. The sensitivity of physicians to depressive symptoms was 39% in the i ntervention group and 36% in the control group after education (odds ratio 1.2 [95% CI 0.88-1.61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly Improve. Interpretation Although well received, this in-practice programme, which wa s designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery fro m depression.