Evaluation of a Mental Health Physician Support Program in Nova Scotia
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ClinicalTrials.gov Identifier: NCT01975948 |
Recruitment Status :
Completed
First Posted : November 5, 2013
Results First Posted : June 26, 2017
Last Update Posted : October 14, 2021
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Tracking Information | |||||||||||||
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First Submitted Date ICMJE | October 21, 2013 | ||||||||||||
First Posted Date ICMJE | November 5, 2013 | ||||||||||||
Results First Submitted Date ICMJE | February 1, 2017 | ||||||||||||
Results First Posted Date ICMJE | June 26, 2017 | ||||||||||||
Last Update Posted Date | October 14, 2021 | ||||||||||||
Actual Study Start Date ICMJE | November 2013 | ||||||||||||
Actual Primary Completion Date | December 2015 (Final data collection date for primary outcome measure) | ||||||||||||
Current Primary Outcome Measures ICMJE |
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Original Primary Outcome Measures ICMJE |
• Change from Baseline to study end-point of the Patient Health Questionnaire-9(PHQ-9)score in patients [ Time Frame: baseline, 2, 3, and 6 months ] The PHQ-9, developed by Drs. Robert L. Spitzer, Janet B.W. Williams specifically for primary care settings is a self-report instrument which takes only a few minutes to complete. The tool is highly sensitive and specific for the diagnosis of depression, and covers the nine symptom-based DSM-IV (Diagnostic and Statistical Manual) and DSM-5 criteria for major depression. It can also produce dimensional symptom severity ratings. The scale covers a two week time frame, essentially covering current rather than past episodes. The PHQ-9 has been extensively validated and is widely used in primary care as a screening instrument and for monitoring treatment outcomes. A PHQ-9 score >10 has a sensitivity for major depression of 88%, and a specificity of 88%, and a positive likelihood ratio of 7.1.
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Change History | |||||||||||||
Current Secondary Outcome Measures ICMJE |
Between Group Changes in Occupational Functioning From Baseline to 6 Months [ Time Frame: Baseline, 1, 2, 3, and 6 months ] 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.
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Original Secondary Outcome Measures ICMJE |
Lam's Employment Absence and Productivity Scale (LEAPS) [ Time Frame: Baseline, 2,3, and 6 months ] As a measure of occupational functioning, Lam's Employment Absence and Productivity Scale (LEAPS) will be used . This scale was developed in Canada to assess the workplace impact of major depression. LEAPS displayed excellent internal consistency as assessed by Cronbach's alpha: 0.89. During scale development, validity was assessed by comparing the LEAPS to the other clinical and work functioning scales, where it showed excellent concordant validity.
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Current Other Pre-specified Outcome Measures |
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Original Other Pre-specified Outcome Measures |
Health Care Costs Comparison [ Time Frame: Baseline and at 6 months ] For the purposes of quantifying economic impacts, the Client Service Receipt Inventory will be used . This is a well-used and extensively validated inventory.
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Descriptive Information | |||||||||||||
Brief Title ICMJE | Evaluation of a Mental Health Physician Support Program in Nova Scotia | ||||||||||||
Official Title ICMJE | Evaluation of a Mental Health Physician Support Program in Nova Scotia: Impact on Patient Outcomes and Stigmatization | ||||||||||||
Brief Summary | The aim of this study is to test the program's effectiveness in a primary care setting in reducing stigma among medical personnel, increasing the comfort level of physicians and staff in providing care to those living with mental illness, and in improving client well-being and mental health. | ||||||||||||
Detailed Description | Skill-based approaches are effective in reducing stigma in health professionals. Overview: The Nova Scotia (NS) Department of Health and Wellness and the Mental Health Commission of Canada launched a demonstration project in NS-Adult Mental Health Practice Support Program. Originating in British Columbia (BC), it uses a novel learning platform which supports primary healthcare providers with treatment and management of mental illness. We hypothesized that enhanced skills in program participants would lead to increased comfort on the part of practitioners, diminished social distance and stigmatization; improved clinical outcomes and a reduction in healthcare costs. This evaluation has three co-primary objectives:
Two secondary objectives:
Four exploratory objectives:
Methods: Seventy seven practices with one hundred and eleven community-based family physicians were recruited. Each practice was assigned a practice number. Each physician within the practice was assigned a unique identifier number. Individual practitioner or practice teams were randomly assigned to intervention or control groups. Randomization was stratified on the total number of physicians per practice, as well as urban or rural setting to ensure equal distribution of practice clusters and urban and rural groups. STATA, version 12 [College Station, TX, 2012] to generate the sequence for practice [cluster] randomization. Random numbers were generated from a binomial distribution with a probability of success of 0.5. Intervention group participants attended 3 half-day workshops with a "6- week action period" between workshops to practice learnings. Practice support was provided through diagnostic assessment tools, evidence based self-management tools, and on-site practice support coordinator support. A stigma-assessment tool, the Opening Minds Scale for Healthcare Providers (OMS-HC), was administered to both groups at intervention group pre-training, and post-training. Providers comfort and confidence in diagnosing and managing mental illness was also assessed, at comparable times. Upon completion of the intervention group training, physicians from both groups were asked to identify 3 consecutive evaluable patients. Patients were enrolled and allocated to intervention or control groups as per their associated physician. |
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Study Type ICMJE | Interventional | ||||||||||||
Study Phase ICMJE | Not Applicable | ||||||||||||
Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Participant, Outcomes Assessor) Primary Purpose: Health Services Research |
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Condition ICMJE | Major Depressive Disorder | ||||||||||||
Intervention ICMJE |
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Study Arms ICMJE |
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Publications * | Lauria-Horner B, Beaulieu T, Knaak S, Weinerman R, Campbell H, Patten S. Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals' management of depression. BMC Fam Pract. 2018 Nov 28;19(1):183. doi: 10.1186/s12875-018-0862-y. | ||||||||||||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||||||||||
Recruitment Status ICMJE | Completed | ||||||||||||
Actual Enrollment ICMJE |
285 | ||||||||||||
Original Estimated Enrollment ICMJE |
200 | ||||||||||||
Actual Study Completion Date ICMJE | December 2015 | ||||||||||||
Actual Primary Completion Date | December 2015 (Final data collection date for primary outcome measure) | ||||||||||||
Eligibility Criteria ICMJE | Physician sample:
Patient sample: Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender ICMJE |
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Ages ICMJE | 18 Years and older (Adult, Older Adult) | ||||||||||||
Accepts Healthy Volunteers ICMJE | No | ||||||||||||
Contacts ICMJE | Contact information is only displayed when the study is recruiting subjects | ||||||||||||
Listed Location Countries ICMJE | Canada | ||||||||||||
Removed Location Countries | |||||||||||||
Administrative Information | |||||||||||||
NCT Number ICMJE | NCT01975948 | ||||||||||||
Other Study ID Numbers ICMJE | CDHA-RS/2014-150 | ||||||||||||
Has Data Monitoring Committee | Yes | ||||||||||||
U.S. FDA-regulated Product | Not Provided | ||||||||||||
IPD Sharing Statement ICMJE |
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Current Responsible Party | Bianca Horner, Nova Scotia Health Authority | ||||||||||||
Original Responsible Party | Nova Scotia Health Authority | ||||||||||||
Current Study Sponsor ICMJE | Nova Scotia Health Authority | ||||||||||||
Original Study Sponsor ICMJE | Same as current | ||||||||||||
Collaborators ICMJE | Not Provided | ||||||||||||
Investigators ICMJE |
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PRS Account | Nova Scotia Health Authority | ||||||||||||
Verification Date | September 2021 | ||||||||||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |