Unit of Psychiatry, DAME, University of Udine, Udine, Italy.
Department of Biomolecular Sciences-Unit of Medical Statistic and Biometry, University of Urbino 'Carlo Bo', Urbino, Italy.
Fam Pract. 2020 Nov 28;37(6):731-737. doi: 10.1093/fampra/cmaa077.
Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies.
Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care.
This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring ≥11 on Patient Heath Questionnaire and ≥26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview.
Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, χ 2 = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview.
Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression.
The trial was registered on https://clinicaltrials.gov/ on 5 October 2012 with identifier: NCT01701791. The first participant was enrolled on 5 May 2014 and the study was completed on May 2016.
计算机临床决策支持系统（CCDSS）是一种信息技术工具，旨在改善临床决策。远程医疗是一种通过视频会议、电话或消息传递技术提供医疗服务的方式。
我们的项目旨在测试一种复合 CCDSS 和远程医疗方法治疗初级保健中抑郁症的有效性。
这是一项集群随机试验，涉及意大利北部的四个全科医生诊所。两个诊所被分配到实验组，两个作为对照组。研究比较了使用 CCDSS 平台的远程医疗组（TG）和提供常规治疗（TAU）的对照组（CG）。患者的患者健康问卷得分≥11 分，抑郁症状自评量表得分≥26 分者有资格参加。还对患者进行了世界卫生组织生活质量简表评估生活质量和医疗访谈满意度量表 21 评估医疗访谈满意度。
共有 2810 名患者接受了筛查，实验组有 66 名患者，CG 组有 32 名患者通过了筛查阶段并符合纳入标准。在 6 个月时，TG 组的缓解率明显高于 CG 组（24.1%比 3.1%，χ²=6.6，P=0.01）。在调整基线混杂因素后，这种差异仍然显著。两组的身体和心理生活质量均从基线显著改善。患者平均对医疗访谈表示满意。
我们的研究表明，与全科医生提供的常规治疗相比，结合 CCDSS 和远程医疗的方法可能更有效。
该试验于 2012 年 10 月 5 日在 https://clinicaltrials.gov/ 注册，标识符为：NCT01701791。第一名参与者于 2014 年 5 月 5 日入组，研究于 2016 年 5 月完成。
