TY - JOUR
T1 - Antidepressant Advisor (ADeSS)
T2 - a decision support system for antidepressant treatment for depression in UK primary care - a feasibility study
AU - Harrison, Phillippa
AU - Carr, Ewan
AU - Goldsmith, Kimberley
AU - Young, Allan
AU - Ashworth, Mark
AU - Fennema, Diede
AU - Duan, Suqian
AU - Barrett, Barbara M
AU - Zahn, Roland
N1 - © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Funding Information:
This paper represents independent research funded by the National Institute for Health Research (NIHR) research for patient benefit scheme (PB-PG-0416-20039) and independent research part funded (KG, EC, RZ, AY) by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the Applied Research Collaboration South London (NIHR ARC South London) at King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. DF’s PhD is funded by the Medical Research Council Doctoral Training Partnership (project reference: 2064430). The authors acknowledge the support provided to the study by the South London Clinical Research Network and sponsorship by Lambeth CCG.
Funding Information:
Funding This paper represents independent research funded by the National Institute for Health Research (NIHR) research for patient benefit scheme (PB-PG- 0416- 20039) and independent research part funded (KG, EC, RZ, AY) by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London and the Applied Research Collaboration South London (NIHR ARC South London) at King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. DF's PhD is funded by the Medical Research Council Doctoral Training Partnership (project reference: 2064430). The authors acknowledge the support provided to the study by the South London Clinical Research Network and sponsorship by Lambeth CCG.
Funding Information:
AHY is a consultant to Johnson & Johnson and Livanova. AHY has given paid lectures and sat on advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma. AHY has received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova. AHY is the Principal Investigator of the following studies: Restore-Life VNS registry study funded by LivaNova, ESKETINTRD3004: 'An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression', 'The Effects of Psilocybin on Cognitive Function in Healthy Participants' and 'The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD)'. AHY has received grant funding (past and present) from the following: NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK); Janssen (UK). RZ is a private psychiatrist service provider at The London Depression Institute and co-investigator on a Livanova-funded observational study of Vagus Nerve Stimulation for Depression. RZ has received honoraria for talks at medical symposia sponsored by Lundbeck as well as Janssen. He has collaborated with EMIS PLC for this study and advises Depsee Ltd. He is affiliated with the D’Or Institute of Research and Education, Rio de Janeiro and advises the Scients Institute, USA. KG reports grants from NIHR, Stroke association, National Institutes of Health (USA) and Juvenile Diabetes Research Foundation (USA) during the conduct of the study. EC reports personal fees from NIHR during the conduct of the study. BMB reports grants from NIHR, National Institutes of Health (USA) and Guys and St. Thomas’ Foundation during the conduct of the study. The other authors report no competing interests.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
PY - 2023/3/3
Y1 - 2023/3/3
N2 - OBJECTIVES: To develop and probe the first computerised decision-support tool to provide antidepressant treatment guidance to general practitioners (GPs) in UK primary care.DESIGN: A parallel group, cluster-randomised controlled feasibility trial, where individual participants were blind to treatment allocation.SETTING: South London NHS GP practices.PARTICIPANTS: Ten practices and eighteen patients with treatment-resistant current major depressive disorder.INTERVENTIONS: Practices were randomised to two treatment arms: (a) treatment-as-usual, (b) computerised decision support tool.RESULTS: Ten GP practices participated in the trial, which was within our target range (8-20). However, practice and patient recruitment were slower than anticipated and only 18 of 86 intended patients were recruited. This was due to fewer than expected patients being eligible for the study, as well as disruption resulting from the COVID-19 pandemic. Only one patient was lost to follow-up. There were no serious or medically important adverse events during the trial. GPs in the decision tool arm indicated moderate support for the tool. A minority of patients fully engaged with the mobile app-based tracking of symptoms, medication adherence and side effects.CONCLUSIONS: Overall, feasibility was not shown in the current study and the following modifications would be needed to attempt to overcome the limitations found: (a) inclusion of patients who have only tried one Selective Serotonin Reuptake Inhibitor, rather than two, to improve recruitment and pragmatic relevance of the study; (b) approaching community pharmacists to implement tool recommendations rather than GPs; (c) further funding to directly interface between the decision support tool and self-reported symptom app; (d) increasing the geographic reach by not requiring detailed diagnostic assessments and replacing this with supported remote self-report.TRIAL REGISTRATION NUMBER: NCT03628027.
AB - OBJECTIVES: To develop and probe the first computerised decision-support tool to provide antidepressant treatment guidance to general practitioners (GPs) in UK primary care.DESIGN: A parallel group, cluster-randomised controlled feasibility trial, where individual participants were blind to treatment allocation.SETTING: South London NHS GP practices.PARTICIPANTS: Ten practices and eighteen patients with treatment-resistant current major depressive disorder.INTERVENTIONS: Practices were randomised to two treatment arms: (a) treatment-as-usual, (b) computerised decision support tool.RESULTS: Ten GP practices participated in the trial, which was within our target range (8-20). However, practice and patient recruitment were slower than anticipated and only 18 of 86 intended patients were recruited. This was due to fewer than expected patients being eligible for the study, as well as disruption resulting from the COVID-19 pandemic. Only one patient was lost to follow-up. There were no serious or medically important adverse events during the trial. GPs in the decision tool arm indicated moderate support for the tool. A minority of patients fully engaged with the mobile app-based tracking of symptoms, medication adherence and side effects.CONCLUSIONS: Overall, feasibility was not shown in the current study and the following modifications would be needed to attempt to overcome the limitations found: (a) inclusion of patients who have only tried one Selective Serotonin Reuptake Inhibitor, rather than two, to improve recruitment and pragmatic relevance of the study; (b) approaching community pharmacists to implement tool recommendations rather than GPs; (c) further funding to directly interface between the decision support tool and self-reported symptom app; (d) increasing the geographic reach by not requiring detailed diagnostic assessments and replacing this with supported remote self-report.TRIAL REGISTRATION NUMBER: NCT03628027.
KW - Humans
KW - Feasibility Studies
KW - Depression
KW - Depressive Disorder, Major
KW - Pandemics
KW - COVID-19
KW - Antidepressive Agents
KW - London
KW - Primary Health Care
UR - http://www.scopus.com/inward/record.url?scp=85149555422&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-060516
DO - 10.1136/bmjopen-2021-060516
M3 - Article
C2 - 36868594
SN - 2044-6055
VL - 13
SP - e060516
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e060516
ER -