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

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• 作者：Gerdien Franx (22)
  Jochanan Huyser (23)
  Jan Koetsenruijter (24)
  Christina M van der Feltz-Cornelis (22) (25) (26)
  Peter FM Verhaak (27) (28)
  Richard PTM Grol (24)
  Michel Wensing (24)
  
  22. Trimbos Institute ; Netherlands institute of mental health and addiction ; PO Box 725 ; 3500 ; AS ; Utrecht ; the Netherlands
  23. Arkin ; PO Box 75848 ; 1070 ; AV ; Amsterdam ; the Netherlands
  24. Scientific Institute for Quality of Healthcare ; Radboud University Nijmegen Medical Centre ; PO Box 9101 ; 114 ; 6500 ; HB ; Nijmegen ; the Netherlands
  25. Tranzo ; Tilburg School of Social and Behavioral Sciences ; Tilburg University ; PO Box 90153 ; 5000 ; LE ; Tilburg ; the Netherlands
  26. Clinical Centre for Body ; Mind and Health ; GGz Breburg ; PO Box 770 ; 5000 ; AT ; Tilburg ; the Netherlands
  27. Nivel ; Netherlands institute for health services research ; PO Box 1568 ; 3500 ; BN ; Utrecht ; the Netherlands
  28. Rijksuniversiteit Universiteit Groningen ; University Medical Centre Groningen ; dep. General Practice ; PO Box 196 ; FA20 ; 9700 ; AD ; Groningen ; the Netherlands
  
• 关键词：General practice ; Guidelines ; Antidepressants ; Implementation ; Stepped care
• 刊名：BMC Family Practice
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：15
• 期：1
• 全文大小：357 KB
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  42. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2296/15/35/prepub
  
• 刊物主题：General Practice / Family Medicine; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1471-2296

文摘

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.