Trial Outcomes & Findings for Evaluation of a Mental Health Physician Support Program in Nova Scotia (NCT NCT01975948)
NCT ID: NCT01975948
Last Updated: 2021-10-14
Results Overview
The Patient Health Questionnaire-9 (PHQ-9) covers nine symptom-based Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depressive disorder. Scores range from 0-27, with higher scores indicating more severe depression severity. We compared between-group mean differences of PHQ-9 scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal PHQ-9 ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.
COMPLETED
NA
285 participants
Baseline, 1, 2, 3, and 6 months
2021-10-14
Participant Flow
Seventy seven practices with one hundred and eleven community-based family physicians were recruited between September 2013 and January 2014.
285 participants were enrolled in the study: Physicians (n=111);Patients (n=129); Medical office Staff (MOAs) (n=45) MOA Group: MOAs excluded from outcome analysis due to inconsistent particpation and small sample size
Participant milestones
| Measure |
Mental Health Practice Support Program;Physician Sample
Physician training in Adult Mental Health Practice Support Program
Mental Health Practice Support Program: (1) training and (2) practice support.
•Three half day workshop sessions over a 24 week period.
•Practice support: 3 evidence based Supported Self Management tools (Cognitive Behavioral Interpersonal Skills Manual,Bounceback program, Antidepressant Skills Workbook), and Practice support coordinator provides guidance to incorporate newly acquired tools, skills, and processes
|
Depression Treatment as Usual;Physician Sample
Treatment as Usual for Depression
Depression Treatment as Usual: Physicians manage patients with depression as usual
|
Mental Health Practice Support Program;Patient Sample
Patients were assigned to the same arm as their physician who were randomized to the Practice Support Program training. Patients were enrolled between June 2014-May 2015 with the last follow-up visit in November 2015
|
Treatment as Usual: Patient Sample
Patients were assigned to the same arm as their physician, who were randomized to treating their patients as usual. Patients were enrolled between June 2014-May 2015 with the last follow-up visit in November 2015
|
|---|---|---|---|---|
|
Overall Study
STARTED
|
56
|
55
|
72
|
57
|
|
Overall Study
COMPLETED
|
39
|
34
|
65
|
51
|
|
Overall Study
NOT COMPLETED
|
17
|
21
|
7
|
6
|
Reasons for withdrawal
| Measure |
Mental Health Practice Support Program;Physician Sample
Physician training in Adult Mental Health Practice Support Program
Mental Health Practice Support Program: (1) training and (2) practice support.
•Three half day workshop sessions over a 24 week period.
•Practice support: 3 evidence based Supported Self Management tools (Cognitive Behavioral Interpersonal Skills Manual,Bounceback program, Antidepressant Skills Workbook), and Practice support coordinator provides guidance to incorporate newly acquired tools, skills, and processes
|
Depression Treatment as Usual;Physician Sample
Treatment as Usual for Depression
Depression Treatment as Usual: Physicians manage patients with depression as usual
|
Mental Health Practice Support Program;Patient Sample
Patients were assigned to the same arm as their physician who were randomized to the Practice Support Program training. Patients were enrolled between June 2014-May 2015 with the last follow-up visit in November 2015
|
Treatment as Usual: Patient Sample
Patients were assigned to the same arm as their physician, who were randomized to treating their patients as usual. Patients were enrolled between June 2014-May 2015 with the last follow-up visit in November 2015
|
|---|---|---|---|---|
|
Overall Study
Withdrawal by Subject
|
17
|
21
|
7
|
6
|
Baseline Characteristics
Evaluation of a Mental Health Physician Support Program in Nova Scotia
Baseline characteristics by cohort
| Measure |
Practice Support Program: Physician Sample
n=39 Participants
Physician training in Adult Mental Health Practice Support Program
Mental Health Practice Support Program: (1) training and (2) practice support.
•Three half day workshop sessions over a 24 week period.
•Practice support: 3 evidence based Supported Self Management tools (Cognitive Behavioral Interpersonal Skills Manual,Bounceback program, Antidepressant Skills Workbook), and Practice support coordinator provides guidance to incorporate newly acquired tools, skills, and processes
|
Treatment as Usual: Physician Sample
n=34 Participants
Treatment as Usual for Depression
Depression Treatment as Usual: Physicians manage patients with depression as usual
|
Practice Support Program: Patient Sample
n=65 Participants
Patients of physicians trained in the Adult Mental Health Practice Support Program.
Inclusion criteria included \>18 years of age, with a diagnosis of depression, PHQ-9 score of \> 10, able to read and speak in English at grade 6 level, and intact cognitive functioning (physician judgment). Exclusion criteria included active treatment with antidepressants within 5 weeks and psychotherapy within 3 months of enrollment, and clinically judged urgent or emergent medical/psychiatric condition by their physician.
|
Treatment as Usual: Patient Sample
n=51 Participants
Patients of physician who were randomized in the control group (TAU).
Inclusion criteria included \>18 years of age, with a diagnosis of depression, PHQ-9 score of \> 10, able to read and speak in English at grade 6 level, and intact cognitive functioning (physician judgment). Exclusion criteria included active treatment with antidepressants within 5 weeks and psychotherapy within 3 months of enrollment, and clinically judged urgent or emergent medical/psychiatric condition by their physician.
|
Total
n=189 Participants
Total of all reporting groups
|
|---|---|---|---|---|---|
|
Age, Customized
Physician 20-29years
|
0 participants
n=5 Participants
|
2 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Age, Customized
Physician 30-39years
|
8 participants
n=5 Participants
|
5 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Age, Customized
Physician 40-49years
|
10 participants
n=5 Participants
|
14 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Age, Customized
Physician 50-59years
|
16 participants
n=5 Participants
|
10 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Age, Customized
Physician 60-69years
|
5 participants
n=5 Participants
|
3 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Age, Customized
Patients 18-29 years
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
11 Participants
n=5 Participants
|
12 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Age, Customized
Patients 30-39 years
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
13 Participants
n=5 Participants
|
18 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Age, Customized
Patients 40-49 years
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
14 Participants
n=5 Participants
|
8 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Age, Customized
Patients 50-59 years
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
9 Participants
n=5 Participants
|
7 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Age, Customized
Patients 60-69 years
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
9 Participants
n=5 Participants
|
3 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Age, Customized
Patients >70 years
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
5 Participants
n=5 Participants
|
1 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Sex: Female, Male
Female
|
21 Participants
n=5 Participants
|
21 Participants
n=7 Participants
|
45 Participants
n=5 Participants
|
40 Participants
n=4 Participants
|
127 Participants
n=21 Participants
|
|
Sex: Female, Male
Male
|
18 Participants
n=5 Participants
|
13 Participants
n=7 Participants
|
20 Participants
n=5 Participants
|
11 Participants
n=4 Participants
|
62 Participants
n=21 Participants
|
|
Region of Enrollment
Canada
|
39 participants
n=5 Participants
|
34 participants
n=7 Participants
|
65 participants
n=5 Participants
|
51 participants
n=4 Participants
|
189 participants
n=21 Participants
|
|
Years in practice
Less than 1 year
|
0 participants
n=5 Participants
|
2 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
1-4years
|
7 participants
n=5 Participants
|
2 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
5-9years
|
3 participants
n=5 Participants
|
3 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
10-14years
|
3 participants
n=5 Participants
|
5 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
15-19years
|
1 participants
n=5 Participants
|
6 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
20-24years
|
9 participants
n=5 Participants
|
3 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
25-29years
|
9 participants
n=5 Participants
|
7 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Years in practice
30 years or more
|
5 participants
n=5 Participants
|
6 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Pattern of work
Full time
|
34 participants
n=5 Participants
|
29 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Pattern of work
Part time
|
5 participants
n=5 Participants
|
5 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Practice type
Solo practice
|
9 participants
n=5 Participants
|
5 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Practice type
2-physician practice
|
8 participants
n=5 Participants
|
5 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Practice type
Small gp practice (<5)
|
16 participants
n=5 Participants
|
8 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Practice type
Large gp practice (5+)
|
5 participants
n=5 Participants
|
16 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Unique patients/yr
Fewer than 1,000
|
6 participants
n=5 Participants
|
7 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Unique patients/yr
1,000-1,999
|
12 participants
n=5 Participants
|
12 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Unique patients/yr
2,000-2,999
|
2 participants
n=5 Participants
|
7 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Unique patients/yr
3,000 or more
|
11 participants
n=5 Participants
|
6 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Unique patients/yr
Other (hospitalist, locum, etc)
|
2 participants
n=5 Participants
|
0 participants
n=7 Participants
|
NA participants
n=5 Participants
|
NA participants
n=4 Participants
|
NA participants
n=21 Participants
|
|
Marital Status
Patients: Married/common-law
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
33 Participants
n=5 Participants
|
32 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Marital Status
Patients: Separated/divorced
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
11 Participants
n=5 Participants
|
5 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Marital Status
Patients: Never married
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
17 Participants
n=5 Participants
|
10 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Marital Status
Patients: Widowed
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
0 Participants
n=5 Participants
|
2 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Employment status
Patients: Employed full time
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
27 Participants
n=5 Participants
|
26 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Employment status
Patients:Employed part time
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
8 Participants
n=5 Participants
|
13 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Employment status
Patients:Unemployed but available to work
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
5 Participants
n=5 Participants
|
2 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Employment status
Patients:Unemployed due to illness
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
6 Participants
n=5 Participants
|
3 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Employment status
Patients:Retired/student/at-home/other
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
5 Participants
n=5 Participants
|
15 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Education
Some elementary or high school
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
8 Participants
n=5 Participants
|
2 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Education
High school diploma
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
14 Participants
n=5 Participants
|
6 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Education
Some post-secondary
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
5 Participants
n=5 Participants
|
10 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Education
Post-secondary certificate/diploma
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
14 Participants
n=5 Participants
|
17 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Education
Post-secondary degree
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
15 Participants
n=5 Participants
|
13 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Education
Master's degree or higher
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
5 Participants
n=5 Participants
|
1 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Mother tongue
Patient: English
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
56 Participants
n=5 Participants
|
48 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Mother tongue
Patient: French
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
3 Participants
n=5 Participants
|
0 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Mother tongue
Patient: Other
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
2 Participants
n=5 Participants
|
1 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Who do you usually live with?
Patient: Husband/wife/steady partner
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
18 Participants
n=5 Participants
|
17 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Who do you usually live with?
Patient:Spouse partner and children
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
15 Participants
n=5 Participants
|
19 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Who do you usually live with?
Patient:Children (but no spouse/partner)
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
4 Participants
n=5 Participants
|
2 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Who do you usually live with?
Patient:Parents
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
4 Participants
n=5 Participants
|
4 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Who do you usually live with?
Patient:Alone
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
13 Participants
n=5 Participants
|
6 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
|
Who do you usually live with?
Patient:Other
|
NA Participants
n=5 Participants
|
NA Participants
n=7 Participants
|
6 Participants
n=5 Participants
|
1 Participants
n=4 Participants
|
NA Participants
n=21 Participants
|
PRIMARY outcome
Timeframe: Baseline, 1, 2, 3, and 6 monthsPopulation: All participants with at least one follow-up data (n=116) were included in the analysis
The Patient Health Questionnaire-9 (PHQ-9) covers nine symptom-based Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depressive disorder. Scores range from 0-27, with higher scores indicating more severe depression severity. We compared between-group mean differences of PHQ-9 scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal PHQ-9 ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=65 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=51 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Depression Severity (Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline
baseline
|
16.43 units on a scale
Standard Deviation 4.77
|
17.28 units on a scale
Standard Deviation 4.12
|
|
Depression Severity (Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline
1 month
|
11.25 units on a scale
Standard Deviation 5.82
|
10.39 units on a scale
Standard Deviation 6.49
|
|
Depression Severity (Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline
2 months
|
9.72 units on a scale
Standard Deviation 6.28
|
8.46 units on a scale
Standard Deviation 6.47
|
|
Depression Severity (Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline
3 months
|
8.44 units on a scale
Standard Deviation 6.15
|
7.55 units on a scale
Standard Deviation 6.13
|
|
Depression Severity (Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline
6 month
|
6.78 units on a scale
Standard Deviation 5.41
|
8.42 units on a scale
Standard Deviation 6.57
|
PRIMARY outcome
Timeframe: Baseline and at 6 monthsThe Opening Minds Scale for Health Care Providers (OMS-HC) is a 15 item validated scale that also captures three main dimensions of stigma; negative attitudes, health professionals' own willingness to disclose/seek help for a mental illness, and preference for greater social distance. Items are rated on a 5-point scale: from strongly agree to strongly disagree. Total scores can range from 15 to 75 for the overall total score, 6 to 30, 4-29, 5-25 for sub-scales respectively. Total scores are averaged to result in mean scores range from 1 to 5 with lower scores indicating less stigma. This scale has been widely validated and used in evaluations of anti-stigma interventions in Canada. The analysis was conducted using a multi-level mixed model in which physicians were clustered within practices and stigma ratings were clustered within physicians (one or two observations per physician). The effect of the intervention was measured in this analysis as an intervention by time interaction.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=39 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=34 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
OMS-HC Total Score Baseline
|
2.21 units on a scale
Standard Deviation .40
|
2.11 units on a scale
Standard Deviation .35
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
OMS-HC Total Score 6 months
|
2.07 units on a scale
Standard Deviation .46
|
2.07 units on a scale
Standard Deviation .38
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
Attitudes subscale:Baseline
|
2.13 units on a scale
Standard Deviation .48
|
2.02 units on a scale
Standard Deviation .48
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
Attitudes subscale: 6 months
|
1.97 units on a scale
Standard Deviation .49
|
1.9 units on a scale
Standard Deviation .51
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
Disclosure/help-seeking: Baselinr
|
2.65 units on a scale
Standard Deviation .66
|
2.65 units on a scale
Standard Deviation .61
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
Disclosure/help-seeking: 6 months
|
2.57 units on a scale
Standard Deviation .75
|
2.63 units on a scale
Standard Deviation .52
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
Social distance: Baseline
|
1.95 units on a scale
Standard Deviation .46
|
1.77 units on a scale
Standard Deviation .39
|
|
Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)
Social distance : 6 months
|
1.79 units on a scale
Standard Deviation .55
|
1.82 units on a scale
Standard Deviation .48
|
SECONDARY outcome
Timeframe: Baseline, 1, 2, 3, and 6 monthsPopulation: All participants with at least one follow-up data (n=116) were included in the analysis
Lam's Employment Absence and Productivity Scale (LEAPS) is a 7 item scale that assesses workplace impact of major depression. Each item is rated on a 5-point Likert scale with the following response format: none of the time (0%), some of the time (25%), half the time (50%), most of the time (75%), or all the time (100%), scored as 0-4, respectively. Total scores can range from 0-28 with lower scores indicating less disruption.We compared between-group mean differences of LEAPs scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal LEAPs ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=65 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=51 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Group Changes in Occupational Functioning From Baseline to 6 Months
Baseline
|
11.26 units on a scale
Standard Deviation 5.80
|
12.76 units on a scale
Standard Deviation 6.52
|
|
Between Group Changes in Occupational Functioning From Baseline to 6 Months
1 month
|
7.67 units on a scale
Standard Deviation 5.36
|
7.13 units on a scale
Standard Deviation 5.96
|
|
Between Group Changes in Occupational Functioning From Baseline to 6 Months
2 months
|
7.45 units on a scale
Standard Deviation 6.21
|
7.16 units on a scale
Standard Deviation 6.88
|
|
Between Group Changes in Occupational Functioning From Baseline to 6 Months
3 months
|
5.54 units on a scale
Standard Deviation 4.37
|
5.96 units on a scale
Standard Deviation 5.06
|
|
Between Group Changes in Occupational Functioning From Baseline to 6 Months
6 months
|
6.04 units on a scale
Standard Deviation 5.79
|
6.03 units on a scale
Standard Deviation 6.12
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Baseline and 6 monthsA modified version of a British Columbia (BC) developed survey, "Practice Support Program Pre-Post Learning Module Questionnaire" was used. Physician confidence was measured on a three point scale ranging from 'very confident' to 'not at all confident.' Mean scores were averaged and can range from one to three, with lower scores indicating higher confidence. Physicians were asked to their level of confidence to: * diagnose depression * screen for addictions * screen for other mental health conditions * treat depression * treat other mental health disorders * prescribe medications for mental health conditions * assess patients' problems and strengths * overall confidence in quality of mental health care provided * knowledge/awareness of non-pharmaceutical interventions * knowledge/awareness of regional mental health resources for patients Cronbach's alpha .84 at pre-test and .87 at post-test
Outcome measures
| Measure |
Mental Health PSP: Patients
n=39 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=34 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Group Change at 6 Months From Baseline in Physician Confidence and Comfort in Managing Mental Illness
Baseline Management of mental illness
|
2.18 units on a scale
Standard Deviation .39
|
2.03 units on a scale
Standard Deviation .37
|
|
Between Group Change at 6 Months From Baseline in Physician Confidence and Comfort in Managing Mental Illness
6 monthsManagement of mental illness
|
1.80 units on a scale
Standard Deviation .36
|
2.12 units on a scale
Standard Deviation .40
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Baseline and 6 monthsA modified version of a British Columbia (BC) developed survey "Practice Support Program Pre-Post Learning Module Questionnaire" was used. Physicians were also asked to rate their level of familiarity, confidence and comfort with a variety of non-program specific mental health tools and skills for assisting patients with mental health concerns (e.g., PHQ9 \& PHQ2, AUDIT, SMME, MOCA, GAF, GAD-7). Physician confidence was measured on a three point scale ranging from 'very confident' to 'not at all confident. Mean scores were averaged and can range from one to three, with lower mean scores indicating higher levels of comfort, confidence and familiarity. Cronbach's alpha for physicia was .90 at pre-test and .91 at post-test, 3
Outcome measures
| Measure |
Mental Health PSP: Patients
n=39 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=34 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Group Change in Physician Confidence and Comfort With Non-program Specific Tools and Skills
Baseline non-program specific mental health tools
|
2.34 units on a scale
Standard Deviation .4
|
2.27 units on a scale
Standard Deviation .5
|
|
Between Group Change in Physician Confidence and Comfort With Non-program Specific Tools and Skills
6 months non-program specific mental health tools
|
1.81 units on a scale
Standard Deviation .4
|
2.32 units on a scale
Standard Deviation .48
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Baseline and 6 monthsA modified version of a British Columbia (BC) developed survey, Practice Support Program Pre-Post Learning Module Questionnaire was used. Physicians were also asked to rate their level of familiarity, confidence and comfort with a variety of non-program specific mental health tools and skills for assisting patients with mental health concerns (e.g., CBIS manual, electronic hyperlinked mental health algorithm, Bounce Back program DVD, referrals for Bounce Back telephone coaching, ASW and coaching skills, Diagnostic Assessment Interview, Problem List Action Plan, CBIS resource list, CBIS skills handout, Family Physician Guide, and medication algorithm). Physician confidence was measured on a three point scale ranging from 'very confident' to 'not at all confident. Mean scores were averaged and can range from one to three, with lower mean scores indicating higher levels of comfort, confidence and familiarity. Cronbach's alpha was .98 at pre-test and .98 at post-test
Outcome measures
| Measure |
Mental Health PSP: Patients
n=39 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=34 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Group Change in Physician Confidence and Comfort With Program Specific Tools and Skills
Baseline program specific mental health tools
|
2.82 units on a scale
Standard Deviation .31
|
2.80 units on a scale
Standard Deviation .20
|
|
Between Group Change in Physician Confidence and Comfort With Program Specific Tools and Skills
6 months program specific mental health tools
|
1.79 units on a scale
Standard Deviation .44
|
2.64 units on a scale
Standard Deviation .21
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Baseline, 1, 2,3, and 6 monthsPopulation: All participants with at least one follow-up data (n=116) were included in the analysis
The CSI is a 25-item scale to measure the degree or magnitude of client satisfaction with care received. Responses range from 1 to 7. Total raw scores range from 0 to 175, with higher scores representing higher levels of satisfaction. Total scores were averaged reducing the overall score to a 7-point scale. We compared between-group mean differences of CSI scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal CSI ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=65 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=51 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Goup Change in Client Satisfaction Inventory (CSI) From Baseline to 6 Months
Baseline
|
6.3 units on a scale
Standard Deviation .51
|
6.1 units on a scale
Standard Deviation .87
|
|
Between Goup Change in Client Satisfaction Inventory (CSI) From Baseline to 6 Months
I month
|
6.1 units on a scale
Standard Deviation .79
|
6.1 units on a scale
Standard Deviation .95
|
|
Between Goup Change in Client Satisfaction Inventory (CSI) From Baseline to 6 Months
2 months
|
6.2 units on a scale
Standard Deviation .76
|
6.2 units on a scale
Standard Deviation .95
|
|
Between Goup Change in Client Satisfaction Inventory (CSI) From Baseline to 6 Months
3 months
|
6.1 units on a scale
Standard Deviation .93
|
6.1 units on a scale
Standard Deviation .91
|
|
Between Goup Change in Client Satisfaction Inventory (CSI) From Baseline to 6 Months
6 months
|
6.1 units on a scale
Standard Deviation .79
|
6.0 units on a scale
Standard Deviation 1.0
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Baseline, 1, 2, 3 and 6 monthsPopulation: All participants with at least one follow-up data (n=116) were included in the analysis
The Medical Outcomes Short Form (SF-36) assesses quality of life. All questions are scored on a scale from 0 to 100, with 100 representing the highest level of functioning possible. Aggregate scores are compiled as a percentage of the total points possible, using the RAND scoring table.We ompared between-group mean differences of SF-36 scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal SF-36 ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=65 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=51 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Groups Changes in Quality of Life From Baseline to 6 Months.
Baseline
|
54.03 units on a scale
Standard Deviation 14.07
|
54.10 units on a scale
Standard Deviation 12.92
|
|
Between Groups Changes in Quality of Life From Baseline to 6 Months.
1 month
|
57.73 units on a scale
Standard Deviation 17.09
|
62.33 units on a scale
Standard Deviation 15.30
|
|
Between Groups Changes in Quality of Life From Baseline to 6 Months.
2 months
|
61.77 units on a scale
Standard Deviation 18.38
|
67.62 units on a scale
Standard Deviation 15.59
|
|
Between Groups Changes in Quality of Life From Baseline to 6 Months.
3 months
|
62.45 units on a scale
Standard Deviation 21.76
|
66.99 units on a scale
Standard Deviation 18.83
|
|
Between Groups Changes in Quality of Life From Baseline to 6 Months.
6 months
|
67.09 units on a scale
Standard Deviation 20.88
|
69.03 units on a scale
Standard Deviation 21.26
|
OTHER_PRE_SPECIFIED outcome
Timeframe: 6 monthsPopulation: All participants with at least one follow-up data (n=116) were included in the analysis
We compared between group use of antidepressant in both groups using the Client Service Receipt Inventory questionnaire at 6 months.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=65 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=51 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Number of Patients That Were Prescribed Antidepressant (AD) at 6 Months
|
31 Participants
|
35 Participants
|
OTHER_PRE_SPECIFIED outcome
Timeframe: Baseline, 1, 2, 3, and 6 monthsPopulation: All participants with at least one follow-up data (n=116) were included in the analysis
The SDS is a visual analog scale which asks respondents to rate from 0-10 the extent to which symptoms have disputed: a: work/school work; b) social life/leisure activities; c) family life/home responsibilities. Total scores can range from 0-30, with lower scores indicating less disruption. We ompared between-group mean differences of SDS scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal SDS ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.
Outcome measures
| Measure |
Mental Health PSP: Patients
n=65 Participants
Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.
|
Treatment as Usual: Patients
n=51 Participants
Those receiving treatment as usual for depression.
|
|---|---|---|
|
Between Group Change in Sheehan Disability Scale (SDS)
Baseline
|
18.87 units on a scale
Standard Deviation 7.06
|
19.83 units on a scale
Standard Deviation 6.20
|
|
Between Group Change in Sheehan Disability Scale (SDS)
1 month
|
13.87 units on a scale
Standard Deviation 8.19
|
13.03 units on a scale
Standard Deviation 8.99
|
|
Between Group Change in Sheehan Disability Scale (SDS)
2 months
|
13.74 units on a scale
Standard Deviation 9.12
|
9.43 units on a scale
Standard Deviation 8.95
|
|
Between Group Change in Sheehan Disability Scale (SDS)
3 months
|
10.42 units on a scale
Standard Deviation 9.34
|
8.28 units on a scale
Standard Deviation 7.29
|
|
Between Group Change in Sheehan Disability Scale (SDS)
6 months
|
7.64 units on a scale
Standard Deviation 7.27
|
7.86 units on a scale
Standard Deviation 8.46
|
Adverse Events
Mental Health PSP: Patients
Treatment as Usual: Patients
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Dr. Bianca Lauria-Horner
Dalhousie University, Department of Psychiatry
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place