The online version of this article (doi:10.1186/1471-2296-15-35) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
GF carried out the design of the study, the acquisition, analysis and interpretation of data and the draft of the manuscript. JK carried out the statistical analysis of the data and participated in the draft of the manuscript. JH, CvdF and PV have been involved in data interpretation and revising the manuscript for important intellectual content. RG and MW have made substantial contributions to the design of the study, the analysis and interpretation of data and the revision of the manuscript. All authors read and approved the final manuscript.
Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general practice as a first treatment step are considered to be high. The aim of this study was to evaluate the implementation of guideline recommendations on antidepressant prescribing.
A quasi-experimental study with a non-equivalent naturalistic control group and three years follow-up was performed in the general practice setting in the Netherlands. General Practitioners (GPs) participated in a national Quality Improvement Collaborative (QIC), focusing on the implementation of a guideline based model for a stepped care approach to depression. The model consisted of self-help and psychological treatment options for patients with milder symptoms as an alternative to antidepressants in general practice. Changes in antidepressant prescription rates of GPs were documented for a three-year period and compared to those in a control group of GPs, selected from an ongoing national registration network.
A decrease of 23.3% (49.4%-26.1%) in antidepressant prescription rates for newly diagnosed patients with depressive symptoms was found within the intervention group, whereas no difference occurred in the reference group (50.3%-52.6%). The decrease over time was significant, compared to the usual care group (OR 0.44, 95% CI: 0.21-0.92).
An implementation program using stepped care principles for the allocation of depression interventions resulted in reduced antidepressant prescription rates in general practice. GPs can change prescribing behaviour within the context of a QIC.
Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ: Multidisciplinary guideline depression: guideline for diagnostics and treatment of adult clients with a major depressive disorder. 2005, Utrecht: Trimbos-instituut, [in Dutch]
Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ: Revision of the Multidisciplinary guideline for Depression. Guideline for the diagnosis, treatment and care of adult patients with a depressive disorder. 2010, Utrecht: Trimbos-instituut, [in Dutch]
National Collaborating Centre for Mental Health: Depression: the treatment and management of depression in adults: NICE clinical guideline 90. 2009, London: National Institute for Health and Clinical Excellence
New Zealand Guidelines Group: Identification of common mental disorders and management of depression in primary care. 2008, Wellington: New Zealand Guidelines Group
Smolders M, Laurant M, Verhaak P, Prins M, van Marwijk H, Penninx B, Wensing M, Grol R: Adherence to evidence-based guidelines for depression and anxiety disorders is associated with recording of the diagnosis. Gen Hosp Psychiatry. 2009, 31 (5): 460-469. 10.1016/j.genhosppsych.2009.05.011. CrossRefPubMed
Nuijen J, Van Dijk CE, Verhaak PFM, Verheij RA: Trendreport Mental Healthcare. Trendreport Mental Healthcare 2010, part 2. Access and consumption of care. Edited by: Nuijen J. 2010, Utrecht: Trimbos-instituut, 181-235. [in Dutch]
McManus P, Mant A, Mitchell PB, Montgomery WS, Marley J, Auland ME: Recent trends in the use of antidepressant drugs in Australia, 1990–1998. Med J Aust. 2000, 173 (9): 458-461. PubMed
Stichting Farmaceutische Kengetallen: Antidepressant use increases strongly. Pharm Weekbl. 2005, 140 (23): 10-[in Dutch]
Spies T, Mokking H, de Vries RP, Grol R: GP often chooses antidepressants independent of depression severity. Huisarts Wet. 2004, 47 (8): 364-367. [in Dutch] CrossRef
Zwaanswijk M, Verhaak PFM: Effective brief interventions for psychological problems; a synthesis of the evidence on applicability in general practice. 2009, Utrecht: Nivel, [in Dutch]
Katzelnick DJ, Von KM, Chung H, Provost LP, Wagner EH: Applying depression-specific change concepts in a collaborative breakthrough series. Jt Comm J Qual Patient Saf. 2005, 31 (7): 386-397. PubMed
Verheij RA, van Dijk CE, Stirbu-Wagner I, Abrahamse H, Davids R, Braspenning J, Van Althuis T, Korevaar JC: National Information Network General Practice: facts and numbers about Dutch general practice. 2009, Utrecht/Nijmegen: NIVEL/IQ, [in Dutch]
Lamberts HWM: International Classification of Primary Care (ICPC). 1990, Oxford: Oxford University Press
Nuijen J, Volkers AC, Verhaak PFM, Schellevis FG, Groenewegen PP, van den Bos GA: Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity. Psychol Med. 2005, 35: 1185-1195. 10.1017/S0033291705004812. CrossRef
WONCA: International Classification of Health Problems in Primary Care (ICHPPC-2-Defined). 1983, Oxford: Oxford University Press
Hulscher M, Schouten L, Grol R: Quest for Quality and Improved Performance: Collaboratives. 2009, London: The Health Foundation
Franx G, Spijker J, Huyser J, de Doelder P: Reduction in depression: Breakthrough method reduces over treatment. Medisch Contact. 2006, 61 (40): 1592-1595.
Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C: Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001, 27 (2): 63-80. PubMed
Smith MJ: "Doing Well": an initiative to improve depression care [MD Thesis]. 2010, Glasgow: University of Glasgow
Richards DA, Bower P, Pagel C, Weaver A, Utley M, Cape J, Pilling S, Lovell K, Gilbody S, Leibowitz J, Owens L, Paxton R, Hennessy S, Simpson A, Gallivan S, Tomson D, Vasilakis C: Delivering stepped care: an analysis of implementation in routine practice. Implement Sci. 2012, 7: 3-10.1186/1748-5908-7-3. CrossRefPubMedPubMedCentral
Verhaak PFM, Ten Have JJIM, Scholte MM: Competition in psychological care. Medisch Contact. 2007, 40 (2): 1642-1645. [in Dutch]
- Implementing guidelines for depression on antidepressant prescribing in general practice: a quasi-experimental evaluation
Christina M van der Feltz-Cornelis
Peter FM Verhaak
Richard PTM Grol
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II