TY - JOUR
KW - Antidepressive Agents/therapeutic use
KW - Cohort Studies
KW - Cooperative Behavior
KW - Depression/mood disorder
KW - Depressive Disorder, Major/epidemiology/therapy
KW - Electronic Health Records
KW - electronic medical records
KW - Family Practice/methods
KW - Humans
KW - Managed Care
KW - Mental Health
KW - multidisciplinary care
KW - Netherlands/epidemiology
KW - primary care.
KW - Primary Health Care/methods
KW - Psychiatry/statistics & numerical data
KW - Psychology/statistics & numerical data
KW - Referral and Consultation
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Social Work, Psychiatric/methods
AU - L. G. Gidding
AU - M. G. Spigt
AU - G. J. Dinant
A1 - 
AB - BACKGROUND: Numerous intensive research projects to assess the effects of stepped collaborative care (SCC) for depressed patients have been reported in primary care, yet it is unclear how SCC is sustained in usual care. OBJECTIVE: To assess how SCC for depression is actually being used and how it performs in usual primary care by studying medical data that are routinely collected in family practice, outside the research setting. METHODS: Retrospective before and after comparison of electronic medical records (EMR) regarding the implementation of an SCC depression programme in a large primary care organization from 2003 to 2012. Depression care parameters included prevalences, minimal interventions, Beck Depression Inventory-2 (BDI-2), antidepressants, referrals to psychologists and psychiatrists and primary health care consumption. RESULTS: After programme implementation, differentiation between levels of depression severity increased, more patients were treated with minimal interventions and more patients were monitored with BDI-2. These effects occurred in both nonseverely and severely depressed patients, although they were larger for patients registered as nonseverely depressed. Antidepressant prescription rates and referral rates seemed not to have been influenced by the SCC programme. Health care consumption of the depressed patients increased significantly. CONCLUSIONS: The depression care parameters changed to a different extent and at a different pace than after previous implementation initiatives. Future research should identify whether SCC uptake in primary care is best enhanced by intensive external guidance or by making care providers themselves responsible for the implementation. Analyses of EMR can be valuable in monitoring the implementation effects, especially after research projects are completed.
BT - Family practice
C5 - Education & Workforce; HIT & Telehealth
CP - 2
CY - England
DO - 10.1093/fampra/cmt072
IS - 2
JF - Family practice
N2 - BACKGROUND: Numerous intensive research projects to assess the effects of stepped collaborative care (SCC) for depressed patients have been reported in primary care, yet it is unclear how SCC is sustained in usual care. OBJECTIVE: To assess how SCC for depression is actually being used and how it performs in usual primary care by studying medical data that are routinely collected in family practice, outside the research setting. METHODS: Retrospective before and after comparison of electronic medical records (EMR) regarding the implementation of an SCC depression programme in a large primary care organization from 2003 to 2012. Depression care parameters included prevalences, minimal interventions, Beck Depression Inventory-2 (BDI-2), antidepressants, referrals to psychologists and psychiatrists and primary health care consumption. RESULTS: After programme implementation, differentiation between levels of depression severity increased, more patients were treated with minimal interventions and more patients were monitored with BDI-2. These effects occurred in both nonseverely and severely depressed patients, although they were larger for patients registered as nonseverely depressed. Antidepressant prescription rates and referral rates seemed not to have been influenced by the SCC programme. Health care consumption of the depressed patients increased significantly. CONCLUSIONS: The depression care parameters changed to a different extent and at a different pace than after previous implementation initiatives. Future research should identify whether SCC uptake in primary care is best enhanced by intensive external guidance or by making care providers themselves responsible for the implementation. Analyses of EMR can be valuable in monitoring the implementation effects, especially after research projects are completed.
PP - England
PY - 2014
SN - 1460-2229; 0263-2136
SP - 180
EP - 192
EP - 
T1 - Stepped collaborative depression care: primary care results before and after implementation of a stepped collaborative depression programme
T2 - Family practice
TI - Stepped collaborative depression care: primary care results before and after implementation of a stepped collaborative depression programme
U1 - Education & Workforce; HIT & Telehealth
U2 - 24277384
U3 - 10.1093/fampra/cmt072
VL - 31
VO - 1460-2229; 0263-2136
Y1 - 2014
ER -