Background
Methods
Study population
Intervention
Structured activities offered | |
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| A network of multidisciplinary teams |
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| An expert team, teaching the stepped care model; |
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| SMART goal setting, a set of indicators to monitor results and an excel worksheet; |
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| A training for local team coordinators on breakthrough method and data collection; |
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| Four conference days for all improvement teams for exchange and learning; |
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| One conference day for local team coordinators for intensive exchange with the expert team; |
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| Five meetings between local team coordinators, with the expert team present; |
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| Team visits of experts and national project coordinators; |
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| Telephone contact between local and national coordinators; |
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| Written feedback on improvement reports and data charts; |
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| A virtual network environment for exchange of best-practices, a Toolkit of instruments and treatment protocols, online discussions and links to relevant sites; |
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| A two days training problem solving treatment for professionals; |
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| A workshop workflow Improvement. |
Data collection
Data analysis
Results
Characteristics of the patient population
QIC practices (n = 400) | Usual care practices (n = 3956) | ||
---|---|---|---|
Age | 18-35 | 37.5 | 32.3 |
36-50 | 39.3 | 38.5 | |
51-65 | 23.3 | 29.2 | |
Mean | 39.8 | 41.9 | |
Male | 30.0 | 35.1 | |
Female | 70.0 | 64.9 | |
Comorbid anxiety | 4.0 | 5.8 |
Antidepressant prescription
QIC practices | Usual care practices | |||||
---|---|---|---|---|---|---|
2006 | 2007 | 2008 | 2006 | 2007 | 2008 | |
Antidepressant prescription | 49.4 | 32.2* | 26.1* | 50.3 | 47.0 | 52.6 |
Referral to mental healthcare | 11.5 | 16.4 | 11.2 | 10.1 | 13.0* | 9.0 |
N | 87 | 152 | 161 | 1261 | 996 | 1699 |
Referral rates
Factors associated with antidepressant medication and referral to mental healthcare
Antidepressant prescribing | Referral to mental healthcare | ||||
---|---|---|---|---|---|
OR (95% CI) | OR (95% CI) | ||||
Age of patient | 1,03* | (1,03 - 1,04) | 0,97* | (0,96 - 0,98) | |
Sexe of patient (male = ref) | 0,98 | (0,86 - 1,12) | 0,71* | (0,58 - 0,85) | |
Co-morbid anxiety | 1,66* | (1,26 - 2,18) | 0,71 | (0,45 - 1,13) | |
Participation in collaborative | 0,98 | (0,57 - 1,70) | 0,93 | (0,36 - 2,39) | |
Year (CAU) | 2006 (ref) | ||||
2007 | 0,92 | (0,69 - 1,21) | 1,12 | (0,68 - 1,86) | |
2008 | 0,87 | (0,66 - 1,15) | 1,28 | (0,77 - 2,11) | |
Year* collaborative | 2006 (ref) | ||||
2007 | 0,60 | (0,29 - 1,24) | 1,11 | (0,32 - 3,81) | |
2008 | 0,44* | (0,21 - 0,92) | 0,71 | (0,20 - 2,52) | |
ICC | 0.067 | 0.193 |