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”

Abstract

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