Improving Outpatient Care of Depression by Implementing Practice Guidelines
Improving Outpatient Care of Depression by Implementing Practice Guidelines
Objective: Depressive disorders are of great medical and political significance. Although evidence-based guidelines have been published and educational initiatives have been launched to implement them, they are rarely actually used. The aim of the study was to implement clinical practice guidelines for outpatient care of depression using a practice-oriented and interdisciplinary approach.
Design: Controlled clinical trial with a naturalistic design (data collection within routine practice) designed as a prospective pre-post study.
Setting: Outpatient care.
Participants: 29 general practitioners (intervention: 18; control: 11) and 15 psychiatrists (intervention: 11; control: 4). Overall, the treatment of 698 patients (two samples: pre: 361; post: 337) was documented.
Intervention(s): Multifaceted intervention combining benchmarking, continuous medical education and interdisciplinary quality circles for the diagnosis and treatment of depressive disorders.
Main Outcome Measures: Mixed-effects regression models for cluster-adjusted analysis of patients' symptom reduction.
Results: Although physicians in the intervention group improved their clinical effectiveness (proportion of patients with response/remission) to a greater extent than physicians in the control group (intervention: 48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysis failed to prove a statistically significant effect of the intervention on the treatment outcome.
Conclusions: Although no statistically significant improvements were found regarding the outcomes, the action programme provides important work, materials and results for an integrated treatment model for depression.
Approximately 11% of the population has suffered from a depressive disorder over the past 12 months. The medical and social importance of depression is set to increase in developed countries over the next decades. About 50% of depressed patients in primary care are not detected, only around one-third receive adequate treatment, and treatment is complicated by system-related barriers. On the other hand, there is evidence that a guideline-adherent treatment and a better collaboration between primary and specialist care lead to marked improvements.
Evidence-based guidelines on depression have been formulated in many countries and educational initiatives have been started to transfer these into practice. Although it remains unclear how best to implement guidelines into routine care, the adherence to a multilevel care model brings about an evident improvement. Multifaceted implementation strategies including continuing medical education, organizational interventions and regulatory measures have to be combined. The effectiveness of such programmes in improving treatment behaviour has been proven for different diagnoses (e.g. asthma, depression, acute coronary syndrome).
The present paper aims to investigate the effects of a specific training programme for implementing clinical practice guidelines and quality management measures on patient outcome and physicians' treatment measures in the outpatient care of depression.
Abstract and Introduction
Abstract
Objective: Depressive disorders are of great medical and political significance. Although evidence-based guidelines have been published and educational initiatives have been launched to implement them, they are rarely actually used. The aim of the study was to implement clinical practice guidelines for outpatient care of depression using a practice-oriented and interdisciplinary approach.
Design: Controlled clinical trial with a naturalistic design (data collection within routine practice) designed as a prospective pre-post study.
Setting: Outpatient care.
Participants: 29 general practitioners (intervention: 18; control: 11) and 15 psychiatrists (intervention: 11; control: 4). Overall, the treatment of 698 patients (two samples: pre: 361; post: 337) was documented.
Intervention(s): Multifaceted intervention combining benchmarking, continuous medical education and interdisciplinary quality circles for the diagnosis and treatment of depressive disorders.
Main Outcome Measures: Mixed-effects regression models for cluster-adjusted analysis of patients' symptom reduction.
Results: Although physicians in the intervention group improved their clinical effectiveness (proportion of patients with response/remission) to a greater extent than physicians in the control group (intervention: 48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysis failed to prove a statistically significant effect of the intervention on the treatment outcome.
Conclusions: Although no statistically significant improvements were found regarding the outcomes, the action programme provides important work, materials and results for an integrated treatment model for depression.
Introduction
Approximately 11% of the population has suffered from a depressive disorder over the past 12 months. The medical and social importance of depression is set to increase in developed countries over the next decades. About 50% of depressed patients in primary care are not detected, only around one-third receive adequate treatment, and treatment is complicated by system-related barriers. On the other hand, there is evidence that a guideline-adherent treatment and a better collaboration between primary and specialist care lead to marked improvements.
Evidence-based guidelines on depression have been formulated in many countries and educational initiatives have been started to transfer these into practice. Although it remains unclear how best to implement guidelines into routine care, the adherence to a multilevel care model brings about an evident improvement. Multifaceted implementation strategies including continuing medical education, organizational interventions and regulatory measures have to be combined. The effectiveness of such programmes in improving treatment behaviour has been proven for different diagnoses (e.g. asthma, depression, acute coronary syndrome).
The present paper aims to investigate the effects of a specific training programme for implementing clinical practice guidelines and quality management measures on patient outcome and physicians' treatment measures in the outpatient care of depression.
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