Diagnostic and Treatment Concordance Among Primary Care Doctors Delivering Mental Health Care: Results from an Effectiveness-implementation Hybrid Cluster Randomized Controlled Trial of an "Add-on Online Mental Health Training".

BACKGROUND

Training primary care doctors (PCDs) to manage common psychiatric conditions is seen as a key strategy to reduce the treatment gap, but its effects on their diagnostic and treatment skills remain largely unstudied.

METHODS

A hybrid cluster randomized controlled trial compared two PCD training methods: training as usual (TAU; two days of in-person lectures, control group [CG]) versus TAU plus online mental health training (OMHT; 18 hours of interactive modules, study group [SG]). Primary outcomes (diagnostic, treatment, and combined concordance) between PCDs and psychiatrists were evaluated using Cohen's kappa (κ), with group comparisons made via paired t-test.

RESULTS

For identifying anxiety disorders, SG (κ = 0.41) performed better than CG (κ = 0.06; p = .02). Likewise, for somatization disorders, SG had moderate concordance (κ = 0.35), while CG had poor concordance (κ = 0.05; p < .01). For depressive disorders, SG had low concordance (κ = 0.12), while CG showed moderate concordance (κ = 0.58; p < .01). For antidepressant prescription, SG (κ = 0.35) performed better than CG (κ = 0.15; p = .03). Combined concordance for common mental disorders (CMDs) as a domain showed that SG (κ = 0.35) fared better than CG (κ = 0.15, p = .03). Conversely, for severe mental disorders (SMDs), CG (κ = 0.83) performed better than SG (κ = 0.35; p = .03).

CONCLUSIONS

Add-on OMHT enhances PCDs' diagnostic and treatment skills for select conditions, particularly anxiety and somatization, highlighting its potential as a scalable model.

TRIAL REGISTRATION: The trial was registered with the Clinical Trial Registry of India (Registration No. CTRI/2024/02/062906). https://ctri.nic.in/Clinicaltrials/login.php.