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Effectiveness of a task-sharing collaborative care model for identification and management of depressive symptoms in patients with hypertension attending public sector primary care clinics in South Africa: pragmatic parallel cluster randomised controlled trial.
Petersen, Inge; Fairall, Lara; Zani, Babalwa; Bhana, Arvin; Lombard, Carl; Folb, Naomi; Selohilwe, One; Georgeu-Pepper, Daniella; Petrus, Ruwayda; Mntambo, Ntokozo; Kathree, Tasneem; Bachmann, Max; Levitt, Naomi; Thornicroft, Graham; Lund, Crick.
Afiliação
  • Petersen I; Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, South Africa. Howard College, Mazisi Kunene Avenue, Durban, 4001, South Africa. Electronic address: peterseni@ukzn.ac.za.
  • Fairall L; Global King's Health Institute, Kings College London, United Kingdom; Knowledge Translation Unit, University of Cape Town, South Africa. Electronic address: lara.fairall@uct.ac.za.
  • Zani B; Knowledge Translation Unit, University of Cape Town, South Africa. Electronic address: babalwa.zani@uct.ac.za.
  • Bhana A; Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, South Africa. Howard College, Mazisi Kunene Avenue, Durban, 4001, South Africa; Health Systems Research Unit, South African Medical Research Council, South Africa. Electronic address: Arvin.Bhana@gmail.com.
  • Lombard C; Biostatistics Unit, South African Medical Research Council, South Africa. Carl Lombard; Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, South Africa. Electronic address: Carl.Lombard@mrc.ac.za.
  • Folb N; Knowledge Translation Unit, University of Cape Town, South Africa. Electronic address: naomifolb@gmail.com.
  • Selohilwe O; Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, South Africa. Howard College, Mazisi Kunene Avenue, Durban, 4001, South Africa. Electronic address: selohilweone@gmail.com.
  • Georgeu-Pepper D; Knowledge Translation Unit, University of Cape Town, South Africa. Electronic address: daniella.georgeu-pepper@uct.ac.za.
  • Petrus R; School of Applied Human Sciences, University of KwaZulu-Natal, South Africa. Electronic address: petrus@ukzn.ac.za.
  • Mntambo N; School of Applied Human Sciences, University of KwaZulu-Natal, South Africa. Electronic address: Mntambo@ukzn.ac.za.
  • Kathree T; Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, South Africa. Howard College, Mazisi Kunene Avenue, Durban, 4001, South Africa. Electronic address: kathree@ukzn.ac.za.
  • Bachmann M; Norwich Medical School, University of East Anglia, United Kingdom. Electronic address: M.Bachmann@uea.ac.uk.
  • Levitt N; Division of Endocrinology, University of Cape Town, South Africa. Electronic address: naomi.levitt@uct.ac.za.
  • Thornicroft G; Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom. Electronic address: graham.thornicroft@kcl.ac.uk.
  • Lund C; Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa. Elect
J Affect Disord ; 282: 112-121, 2021 03 01.
Article em En | MEDLINE | ID: mdl-33412490
BACKGROUND: We tested the real-world effectiveness of a collaborative task-sharing model on depressive symptom reduction in hypertensive Primary Health Care (PHC) patients in South Africa. METHOD: A pragmatic parallel cluster randomised trial in 20 clinics in the Dr Kenneth Kaunda district, North West province. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Control clinics received care as usual (CAU), involving referral to PHC doctors and/or mental health specialists. Intervention clinics received CAU plus enhanced mental health training and a lay counselling referral service. Participant inclusion criteria were ≥ 18 years old, Patient Health Questionnaire-9 (PHQ-9) score ≥ 9 and receiving hypertension medication. Primary superiority outcome was ≥ 50% reduction in PHQ-9 score at 6 months. Statistical analyses comprised mixed effects regression models and a non-inferiority analysis. TRIAL REGISTRATION NUMBER: NCT02425124. RESULTS: Between April 2015 and October 2015, 1043 participants were enrolled (504 intervention and 539 control); 82% were women; half were ≥ 55 years. At 6 and 12 months follow-up, 91% and 89% of participants were interviewed respectively. One control group participant committed suicide. There was no significant difference in the primary outcome between intervention (N=256/456) and control (N=232/492) groups (55.9% versus 50.9%; adjusted risk difference = -0.04 ([95% CI = -0.19; 0.11], p = 0.6). The difference in PHQ-9 scores was within the defined equivalence limits at 6 and 12 months for the non-inferiority analysis. LIMITATIONS: The trial was limited by low exposure to depression treatment by trial participants and by observed co-intervention in control clinics CONCLUSIONS: Incorporating lay counselling services within collaborative care models does not produce superior nor inferior outcomes to models with specialist only counselling services. FUNDING: This work was supported by the UK Department for International Development [201446] as well as the National Institute of Mental Health, United States of America, grant number 1R01MH100470-01. Graham Thornicroft is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College London and King's College Hospital NHS Foundation Trust.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Depressão / Hipertensão Tipo de estudo: Clinical_trials / Diagnostic_studies / Prognostic_studies Limite: Adolescent / Female / Humans / Male País como assunto: Africa / Europa Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Depressão / Hipertensão Tipo de estudo: Clinical_trials / Diagnostic_studies / Prognostic_studies Limite: Adolescent / Female / Humans / Male País como assunto: Africa / Europa Idioma: En Ano de publicação: 2021 Tipo de documento: Article