TY - JOUR
KW - Adult
KW - Depressive Disorder/psychology/therapy
KW - Evidence-Based Practice
KW - Female
KW - Guideline Adherence
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Selection
KW - Practice Guidelines as Topic
AU - D. Heddaeus
AU - M. Steinmann
AU - A. Daubmann
AU - M. Harter
AU - B. Watzke
A1 - 
AB - In order to optimize patient allocation, guidelines recommend stepped and collaborative care models (SCM) including low-intensity treatments. The aim of this study is to investigate the implementation of guideline-adherent treatments in a SCM for depression in routine care. We analyzed care provider documentation data of n = 569 patients treated within a SCM. Rates of guideline-adherent treatment selections and initializations as well as accordance between selected and initialized treatment were evaluated for patients with mild, moderate and severe depression. Guideline-adherent treatment selection and initialization was highest for mild depression (91% resp. 85%). For moderate depression, guideline-adherent treatments were selected in 68% and applied in 54% of cases. Guideline adherence was lowest for severe depression (59% resp. 19%). In a multiple mixed logistic regression model a significant interaction between guideline adherence in treatment selection/initialization and severity degree was found. The differences between treatment selection and initialization were significant for moderate (OR: 1.8 [95% CI: 1.30 to 2.59; p = 0.0006]) and severe depression (OR: 6.9; [95% CI: 4.24 to 11.25; p < .0001] but not for mild depression (OR = 1.8, [95%-CI: 0.68 to 4.56; p = 0.2426]). Accordance between selected and initialized treatment was highest for mild and lowest for severe depression. We conclude that SCMs potentially improve care for mild depression and guideline adherence of treatment selections. Guideline adherence of treatment initialization and accordance between treatment selection and initialization varies with depression severity. Deficits in treating severe depression adequately may be more a problem of failed treatment initializations than of inadequate treatment selections.
AD - Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland.
BT - PloS one
C5 - General Literature
CP - 12
CY - United States
DO - 10.1371/journal.pone.0208882
IS - 12
JF - PloS one
M1 - Journal Article
N2 - In order to optimize patient allocation, guidelines recommend stepped and collaborative care models (SCM) including low-intensity treatments. The aim of this study is to investigate the implementation of guideline-adherent treatments in a SCM for depression in routine care. We analyzed care provider documentation data of n = 569 patients treated within a SCM. Rates of guideline-adherent treatment selections and initializations as well as accordance between selected and initialized treatment were evaluated for patients with mild, moderate and severe depression. Guideline-adherent treatment selection and initialization was highest for mild depression (91% resp. 85%). For moderate depression, guideline-adherent treatments were selected in 68% and applied in 54% of cases. Guideline adherence was lowest for severe depression (59% resp. 19%). In a multiple mixed logistic regression model a significant interaction between guideline adherence in treatment selection/initialization and severity degree was found. The differences between treatment selection and initialization were significant for moderate (OR: 1.8 [95% CI: 1.30 to 2.59; p = 0.0006]) and severe depression (OR: 6.9; [95% CI: 4.24 to 11.25; p < .0001] but not for mild depression (OR = 1.8, [95%-CI: 0.68 to 4.56; p = 0.2426]). Accordance between selected and initialized treatment was highest for mild and lowest for severe depression. We conclude that SCMs potentially improve care for mild depression and guideline adherence of treatment selections. Guideline adherence of treatment initialization and accordance between treatment selection and initialization varies with depression severity. Deficits in treating severe depression adequately may be more a problem of failed treatment initializations than of inadequate treatment selections.
PP - United States
PY - 2018
SN - 1932-6203; 1932-6203
T1 - Treatment selection and treatment initialization in guideline-based stepped and collaborative care for depression
T2 - PloS one
TI - Treatment selection and treatment initialization in guideline-based stepped and collaborative care for depression
U1 - General Literature
U2 - 30586371
U3 - 10.1371/journal.pone.0208882
VL - 13
VO - 1932-6203; 1932-6203
Y1 - 2018
Y2 - Dec 26
ER -