International Journal for Quality in Health Care Advance Access published online on November 6, 2008
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzn050
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Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial
1 Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
2 Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
3 Department of Psychiatry and Psychotherapy, University of Düsseldorf, Postfach 120510, 40605 Düsseldorf, Germany
4 Department of Psychiatry, University of Leipzig, Johannisallee 20, 04317 Leipzig, Germany
5 Institute for Medical Psychology; University Medical Centre Hamburg-Eppendorf, Martinistraße 52 – S35, 20246 Hamburg, Germany
Objective. Depressive disorders are of great medical and political significance. Although evidence-based guidelines have been published and educational initiatives have been launched to implement them, they are rarely actually used. The aim of the study was to implement clinical practice guidelines for outpatient care of depression using a practice-oriented and interdisciplinary approach.
Design. Controlled clinical trial with a naturalistic design (data collection within routine practice) designed as a prospective pre-post study.
Setting. Outpatient care.
Participants. 29 general practitioners (intervention: 18; control: 11) and 15 psychiatrists (intervention: 11; control: 4). Overall, the treatment of 698 patients (two samples: pre: 361; post: 337) was documented.
Intervention(s). Multifaceted intervention combining benchmarking, continuous medical education and interdisciplinary quality circles for the diagnosis and treatment of depressive disorders.
Main outcome measures. Mixed-effects regression models for cluster-adjusted analysis of patients' symptom reduction.
Results. Although physicians in the intervention group improved their clinical effectiveness (proportion of patients with response/remission) to a greater extent than physicians in the control group (intervention: 48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysis failed to prove a statistically significant effect of the intervention on the treatment outcome.
Conclusions. Although no statistically significant improvements were found regarding the outcomes, the action programme provides important work, materials and results for an integrated treatment model for depression.
Keywords: depression, clinical practice guidelines, implementation, outpatient health care system, quality assurance
Address reprint requests to: Isaac Bermejo, Department of Psychiatry and Psychotherapy, University Medical Centre of Freiburg, Section of Clinical Epidemiology and Health Services Research, Hauptstr. 5, 79104 Freiburg, Germany. Tel: +49-761-270-69-82; Fax: +49-761-270-69-89; E-mail: isaac.bermejo{at}uniklinik-freiburg.de
Accepted for publication October 2, 2008.