The PROMDEP Study: What are general practice staff views and experiences of running a feasibility trial within their practice?

Problem

Depression is common and disabling, and largely treated in general practice. Patient reported outcome measures (PROMs) can help practitioners tailor treatment to patients, and have been shown to improve outcomes of mental health disorders in specialist psychiatric and psychological practice, but have not been subjected to a randomised trial in UK primary care.The aim of this research programme is to carry out a randomised controlled trial of PROMs for the assessment and follow-up monitoring of patients treated for depression in primary care.

Approach

A nested qualitative study within a feasibility trial for a proposed RCT is being conducted in order to explore practitioner views of the feasibility of the study, and their experiences of taking part. Semi-structured interviews have been carried out with GP Practice Staff (including GPs, Nurses, Research Managers/Administrators), to explore the ease of participation; time commitment and study design; perceptions of the PROMs, and their utility in helping to determine appropriate treatments. Thematic analysis of the data has been carried out, aimed at drawing out sub-themes and themes using an iterative constant comparison approach, and seeking contrasting views where possible. Analytic rigour has been optimised using more than one analyst, data trails and cross-checking of coding strategies and interpretation, to identify evidence of bias, over-statement, and discrepancies between the data and initial themes.

Findings

Initial findings suggest that practice staff are positive about the concept of the study, and have highlighted areas of study design that worked well and others that could be improved for the main trial. Perceived patient response to the study has been mostly positive, although some GPs have highlighted that patient motivation to take part has led to some selective screening of patients prior to recruitment. GPs report regular use of some PROMs within usual practice and how taking part in the study may have influenced treatment for new cases of depression.

Consequences

The findings will be used to inform the development and refinement of the study design and procedure for the main trial. Preliminary findings suggest that GP Practices are willing to be involved in the study, and the use of PROMs may be beneficial to patients as it enables them to provide personal feedback to their GP. Allowing patients to have a greater involvement in their management of depression may benefit both the patient at an individual level, as well as reducing the burden of depression on the NHS.