Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Alcohol Drinking/*psychology ; Alcoholics/*psychology ; Depression/*therapy; Adult ; Alcohol Drinking/adverse effects ; Alcohol Drinking/prevention & control ; Alcoholic Intoxication/psychology ; Alcoholism/diagnosis ; Colombia/epidemiology ; Comorbidity ; Delivery of Health Care ; Depression/psychology ; Depressive Disorder/psychology ; Depressive Disorder/therapy ; Female ; Humans ; Male ; Mass Screening/methods ; Mexico/epidemiology ; Middle Aged ; Peru/epidemiology ; Primary Health Care/methods ; Primary Health Care/trends ; Referral and Consultation ; Substance Abuse Detection/methods

Introduction: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare.
Materials and Methods: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status.
Results: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained.
Conclusions: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.
Competing Interests: The authors have declared that no competing interests exist.

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MR/K02325X/1 United Kingdom MRC_ Medical Research Council

Date Created: 20210805 Date Completed: 20210823 Latest Revision: 20240403

20240403

PMC8341512

10.1371/journal.pone.0255594

34352012