General Practitioner (GP) education and screening feedback for improving depression outcomes among primary care patients

Eligible general practice patients will complete a brief (approximately 10 minutes) touchscreen computer survey on a tablet device while in the waiting room prior to their appointment. The survey will screen patients for depression using the Patient Health Questionnaire (PHQ-9). The intervention will comprise both GP and patient directed interventions: Step 1: GP education. Consenting GPs will undertake an online quality improvement activity by completing a clinical e-audit "Depression: Achieve remission, prevent relapse (92162)." The online audit will take approximately 15 hours to complete and will involve the following activities: identifying patients who may benefit from additional or alternative treatments; accessing tools and information on what works in treatment of depression; considering recommending a combination of non-pharmacological approaches as part of a broader management plan; and reviewing response to treatment by routinely assessing mood, thoughts and function and modifying treatment/management accordingly. GPs will be requested to finish the online audit before patient data collection is initiated to earn 40 Category 1 CPD points, subject to approval of the RACGP. GPs will also be provided with a list of established mental health support services as well as mental health emergency phone numbers. Step 2: Pre-GP consultation. Consenting patients will complete the baseline assessment via touchscreen computer prior to their consultation with the GP. Upon survey completion, the web-based software will automatically calculate PHQ-9 scores and summarise information regarding preferences for type of help for depressive symptoms. For those patients who score 10 or more on the PHQ-9, or greater than 0 on item 9, tailored feedback of the patient's survey results will be provided to GPs. Step 3: GP consultation. The feedback will provide GPs with summarised information about the patient’s severity of depressive symptoms (i.e. PHQ-9 score), willingness to discuss help for depression with their GP and their preferred type of help. Together with the GP’s knowledge of the patient’s personal and medical history, this information can be used by the GP to guide secondary screening to determine whether some other cause (e.g. recent bereavement, illness, medication) is contributing to the patient’s symptoms, or some action to treat depression is needed. If the GP deems further action necessary, they can use the information provided to explore preferences for care and barriers to acceptance of particular treatment approaches. Step 4: Patient self-management strategies. GPs will also be provided with printed brochures on self-management strategies that can be offered to patients at the GPs discretion. For example, they may be offered to patients who indicate a preference for self-management strategies; or to those for whom self-management strategies are likely to be a useful adjunct to the agreed treatment approach. The brochures will comprise of the publicly available "beyondblue Connect toolkit." The toolkit consists of six worksheets with information and general advice for improving wellbeing through activities such as simple cognitive behavioural strategies. The toolkit also includes telephone and web contact details for beyondblue mental health support services.