Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia; professor of eHealth and primary care, Research Department of Primary Care and Population Health, University College London, London, UK.
Br J Gen Pract. 2021 Jan 28;71(703):e85-e94. doi: 10.3399/BJGP.2020.0783. Print 2021.
Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required.
To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care.
Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18-65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care.
The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months.
In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was -0.88 (95% confidence interval [CI] = -1.45 to -0.31) favouring the intervention, and -0.59 at 12 months (95% CI = -1.18 to 0.01); standardised effect sizes of -0.16 (95% CI = -0.26 to -0.05) and -0.10 (95% CI = -0.21 to 0.002), respectively. No serious adverse events were reported.
Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.
精神卫生治疗率正在上升，但疾病负担并未减轻。需要有工具来支持有效的资源分配。
研究以症状严重程度预后为导向的以人为本的电子健康（Target-D）平台是否可以改善抑郁症状，与常规护理相比。
2016 年 4 月至 2019 年 2 月，在澳大利亚墨尔本的 14 家普通诊所进行分层个体随机对照试验。共有 1868 名年龄在 18-65 岁之间、有当前抑郁症状、有互联网接入、最近未改变抗抑郁药、无当前抗精神病药、无当前心理治疗的参与者被随机（1:1）通过计算机生成的分配到干预组或常规护理组。
干预措施是在全科医生候诊室使用电子健康平台，包括症状反馈、优先级设置和预后匹配的管理选项（在线自助、在线引导心理治疗或护士主导的协作护理）。管理选项具有灵活性，参与者和工作人员均未被蒙蔽，也没有实质性的方案偏离。主要结局是 3 个月时的抑郁症状严重程度（9 项患者健康问卷 [PHQ-9]）。
在意向治疗分析中，估计 3 个月时手臂间平均 PHQ-9 评分的差值为-0.88（95%置信区间 [CI] = -1.45 至 -0.31），有利于干预，12 个月时为-0.59（95%CI = -1.18 至 0.01）；标准化效应大小分别为-0.16（95%CI = -0.26 至 -0.05）和-0.10（95%CI = -0.21 至 0.002）。未报告严重不良事件。
使用以人为本的电子健康平台根据预后匹配管理可改善 3 个月时的抑郁症状，与常规护理相比，且在规模上可能可行。存在增强管理选择的接受度的空间。
