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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Implementing guidelines for depression on antidepressant prescribing in general practice: a quasi-experimental evaluation

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Gerdien Franx, Jochanan Huyser, Jan Koetsenruijter, Christina M van der Feltz-Cornelis, Peter FM Verhaak, Richard PTM Grol, Michel Wensing
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-35) contains supplementary material, which is available to authorized users.

Competing interest

The authors declare that they have no competing interests.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.
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