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Impact of the WHO depression guideline on patient care by psychiatrists: A randomized controlled trial

Published online by Cambridge University Press:  16 April 2020

Michel Linden ,
Anja Westram ,
Lutz G. Schmidt  and
Clemenz Haag
Michel Linden*
Affiliation:
Research Group Psychosomatic Rehabilitation at the Charité, University Medicine Berlin and the Rehabilitation Centre Seehof, Lichterfelder Allee 55, 14513Teltow/Berlin, Germany
Anja Westram
Affiliation:
Research Group Psychosomatic Rehabilitation at the Charité, University Medicine Berlin and the Rehabilitation Centre Seehof, Lichterfelder Allee 55, 14513Teltow/Berlin, Germany
Lutz G. Schmidt
Affiliation:
Department of Psychiatry, Johannes–Gutenberg Universität, Mainz, Germany
Clemenz Haag
Affiliation:
Organon GmbH Germany, Oberschleissheim, Germany
*
*Corresponding author. Tel.: +049 03328 345678; fax: +049 03328 345555. E-mail address: michael.linden@charite.de (M. Linden).
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Abstract

Background

Scientific literature reviews aim to summarize the state of knowledge and published empirical evidence. In contrast, medical guidelines are intervention tools that aim to improve physician behaviour and patient outcome. They can have positive effects, but they can also have negative effects. Their effects must be tested by research.

Methods

In a randomized controlled trial, 103 psychiatrists in private practice were either provided with the WHO depression guideline only (information group), or provided with the WHO depression guideline and trained for one day in this guideline (intervention group), or left uninformed (control group). They then treated a total of 497 patients according to individual clinical considerations and the needs of the patients. Observation of routine treatment lasted 12 weeks. Physicians and patients documented the course of illness and treatment, including the patient–physician interaction.

Results

Psychiatrists in the intervention group saw more psychosocial stressors in their patients, prescribed higher dosages of medication, had fewer drop-outs, and rated treatment outcome as better. The ratings of patient–physician interactions indicated more strain in their relationships.

Conclusions

The results show both positive and negative effects of guideline exposure, but only in the training group and not in the information group. Guidelines should be empirically tested before being called “evidence based”. Every guideline should also explain how it can or must be implemented in order to become effective.

Keywords

Treatment guidelinesDepressionRandomized controlled trialEvidence-based medicinePsychiatristsContinuing medical education
Type
Original article
Information
European Psychiatry , Volume 23 , Issue 6 , September 2008 , pp. 403 - 408
Copyright
Copyright © Elsevier Masson SAS 2008

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References

Azocar, F.Cuffel, B.Goldmann, W.McCarter, L.The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization J Behav Health Serv Res. 30 Pt 1 2003 109–118CrossRefGoogle Scholar
Baker, R.Reddish, S.Robertson, N.Hearnshaw, H.Jones, B.Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice Br J Gen Pract. 51 2001 737–741Google ScholarPubMed
Burvill, P.W.Mowry, W.D.Hall, W.D.Quantification of physical illness in psychiatric research in the elderly Int J Geriatr Psychiatry. 5 1990 161–170CrossRefGoogle Scholar
Callahan, C.M.Hendrie, H.C.Dittus, R.Brater, D.C.Hui, S.L.Tierney, W.M.Proving treatment of late life depression in primary care: a randomized clinical trial J Am Geriatr Soc. 42 1994 839–846CrossRefGoogle Scholar
Clade, H.Medizinische Leitlinien. Entscheidungshilfe für Arzt und Patienten. Juristen warnen davor, evidenzbasierte medizinische Leitlinien als Disziplinierungsinstrumente gegen Ärzte einzusetzen Deutsches Ärzteblatt. 98 2001 B247–B248Google Scholar
Croudace, T.Evans, J.Harrison, G.Sharp, D.J.Wilkinson, E.McCann, G.et al.Impact of the ICD-10 primary health care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care Br J Psychiatry. 182 2003 20–30CrossRefGoogle ScholarPubMed
Fähndrich, E.Linden, M.Zur Reliabilität und Validität der Stimmungsmessung mit der Visuellen Ana-log-skala (VAS) Pharmacopsychiatria. 15 1982 90–94CrossRefGoogle Scholar
Gore, A.Speech to the Democratic National Convention USA Today. August; 2000 18Google Scholar
Greco, P.J.Eisenberg, J.M.Changing physicians practices N Engl J Med. 329 1993 1271–1274CrossRefGoogle Scholar
Keitner, G.I.Ryan, C.E.Solomon, D.A.Realistic expectations and a disease management model for depressed patients with persistent symptoms J Clin Psychiatry. 67 2006 1412–1421CrossRefGoogle Scholar
Koller, M.Lorenz, W.Ziele des Heilens und Konzepte von Outcome in der modernen Medizin Recht Politik Gesundheitswesen. 8 2002 18–25Google Scholar
Langhoff C, Baer T, Zubraegel D, Linden M. The therapeutic alliance and treatment outcome in cognitive behaviour therapy of generalized anxiety disorders. J Cogn Psychother (in press).Google Scholar
Lasek, R.Müller-Oerlinghausen, B.Evidence Based Medicine. Ein neues Zeitalter der Medizin? Limitierung der “Evidence Based Medicine”, Mangel an “Evidence” und Probleme bei der Umsetzung von Studienergebnissen in die Praxis Deutsches Ärzteblatt. 95 1998 B1432–B1434Google Scholar
Lin, E.H.B.Simon, G.E.Katzelnick, D.J.Pearson, S.D.Does physician education on depression management improve treatment in primary care? J Gen Intern Med. 16 2001 614–619CrossRefGoogle ScholarPubMed
Linden, M.Der Einfluss von Leitlinien, Standards und ökonomischen Vorgaben auf medizinische Entscheidungsprozesse Z Arztl Fortbild Qualität Gesundheitswesen. 98 2004 200–205Google Scholar
Linden, M.Leitlinien und die Psychologie medizinischer Entscheidungsprozesse bei der Behandlung depressiver Erkrankungen Fortschr Neurol Psychiatr. 73 2005 249–258CrossRefGoogle Scholar
Linden, M.Dierkes, W.Munz, T.Non-pharmacological treatment of psychiatrists in addition to the prescribing of an antidepressant drug Eur Psychiatry. 22 2007 419–426CrossRefGoogle ScholarPubMed
Linden, M.Gothe, H.Dittmann, R.W.Schaaf, B.Early termination of antidepressant drug treatment J Clin Psychopharmacol. 20 2000 523–530CrossRefGoogle ScholarPubMed
Linden, M.Osterheider, M.Nickelsen, T.Schaaf, B.Three types of early termination of antidepressant drug treatment Int Clin Psychopharmacol. 8 1993 345–346CrossRefGoogle ScholarPubMed
Linden, M.Schotte, K.A randomized controlled clinical trial on dosage selection and treatment outcome with doxepin comparing “guideline exposed” and “guideline naive” physicians Pharmacopsychiatry. 40 2007 77–81CrossRefGoogle ScholarPubMed
National Guideline Clearinghouse URL: http://www.guideline.gov/ 2006Google Scholar
National Institute of Mental Health Clinical Global Impressions Guy, W.ECDEU assessment in psychopharmacology. Revised ed 1976 Rockville MD217–222Google Scholar
Schaaf, B.Linden, M.Weber, H.J.An investigation of the representativity of neuropsychiatrists and their patients in a drug utilization observation study on Fluoxetine Pharmacopsychiatry. 30 1997 44–51CrossRefGoogle Scholar
Schmidt, K.Zum Teufel mit den Expertokraten Münch Med Wschr. 144 2002 48–49Google Scholar
Schotte, K.Linden, M.Correlates of low-dosage treatment with antidepressants by psychiatrists and general practitioners Pharmacoepidemiology and Drug Safety. 16 2007 675–680CrossRefGoogle ScholarPubMed
Thompson, C.Kinmonth, A.L.Stevens, L.Peveler, R.C.Stevens, A.Ostler, K.J.et al.Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire depression project randomised controlled trial Lancet. 355 2000 185–191CrossRefGoogle ScholarPubMed
Toprac, M.G.Dennehy, E.B.Carmody, T.J.Crismon, M.L.Miller, A.L.Trivedi, M.H.et al.Implementation of the Texas Medication Algorithm Project patient and family education program J Clin Psychiatry. 67 2006 1362–1372CrossRefGoogle ScholarPubMed
Upton, M.W.M.Evans, M.Goldberg, D.P.Sharp, D.J.Evaluation of ICD-10 PHC mental health guidelines in detecting and managing depression in primary care Br J Psychiatry. 175 1999 476–482CrossRefGoogle ScholarPubMed
Woolf, S.H.Grol, R.Hutchinson, A.Eccles, M.Grimshaw, J.Potential benefits, limitations, and harms of clinical guidelines BMJ. 318 1999 527–530CrossRefGoogle ScholarPubMed
World Health Organization (WHO) Diagnostic and management guidelines for mental disorders in primary care: ICD – 10 Chapter V Primary care version 1996 WHO/Hogrefe & Huber Publishers . Göttingen, Germany 24–25Google Scholar
World Health Organization (WHO) Information package, programme guidelines mental disorders in primary care 1998 WHO/MSA/MNH/EAC/98.1 Genf, SwitzerlandGoogle Scholar
Worrall, G.Angel, J.Chaulk, P.Robbins, M.Effectiveness of an educational strategy to improve family physicians detection and management of depression: a randomized controlled trial CMAJ. 161 Pt 1 1999 37–40Google ScholarPubMed
Zimmermann, M.Mattia, J.L.Posternak, M.A.Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice? Am J Psychiatry. 159 2002 469–473CrossRefGoogle Scholar
Zurhorst, G.Eminenz-basierte, Evidenz-basierte oder Ökologisch-basierte Psychotherapie? Psychotherapeutenjournal. 97 2003 97–104Google Scholar
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