Background: The aim of this study was to evaluate the impact of a multifaceted intervention to
implement an adapted guideline for the management of depression in primary health care.
Methods: A hybrid trial was carried out to determine the effect of a multicomponent provider centred intervention to improve the detection and diagnosis of depression in primary care, as
part of the guideline implementation process, and to collect information about barriers and
facilitators in a real-world context. Before the multicomponent intervention, a descriptive
cross-sectional study was performed to assess the population prevalence of depression in
the participating health centres and to detect possible differences. Subsequently, a quasi experimental two-phase study was carried out with a concurrent control group to assess the
impact of the multicomponent intervention on the main outcomes (detection of depression,
evaluation of its severity and the use of structured methods to support the diagnosis). Results:
Nine-hundred seventy-four patients took part in the first phase. According to their clinical
records, the prevalence of depression ranged from 7.2% to 7.9%, and there were no significant
differences between the health centres scheduled to receive the intervention and those in
the control group. In the experimental phase, 797 randomly selected participants received
the multicomponent intervention. Adjusted multivariable analysis performed before the
implementation revealed no significant differences in depression between the experimental and
control groups. However, after the intervention, modest but significant differences were
observed, which persisted at 1 year after the intervention. Conclusions: A multicomponent
intervention for the implementation of a clinical guideline for the management of depression in
primary care produced improvements in the identification of depression and in the degree of
severity recorded.
