Implementing guidelines for depression on antidepressant prescribing in general practice

A quasi-experimental evaluation

G. Franx, F.G. Huyser, J. van der Koetsenruijter, C.M. van der Feltz-Cornelis, P.F.M. Verhaak, R. Grol, M.J.P. Wensing

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Abstract

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.
Keywords: General practice, Guidelines, Antidepressants, Implementation, Stepped care
Original languageEnglish
Article number35
JournalBMC Family Practice
Volume15
DOIs
Publication statusPublished - 2014

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General Practice
Depression
General Practitioners
Netherlands
Practice Guidelines

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Franx, G. ; Huyser, F.G. ; van der Koetsenruijter, J. ; van der Feltz-Cornelis, C.M. ; Verhaak, P.F.M. ; Grol, R. ; Wensing, M.J.P. / Implementing guidelines for depression on antidepressant prescribing in general practice : A quasi-experimental evaluation. In: BMC Family Practice. 2014 ; Vol. 15.
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title = "Implementing guidelines for depression on antidepressant prescribing in general practice: A quasi-experimental evaluation",
abstract = "BackgroundInternationally, 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.MethodsA 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.ResultsA 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).ConclusionsAn 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.Keywords: General practice, Guidelines, Antidepressants, Implementation, Stepped care",
author = "G. Franx and F.G. Huyser and {van der Koetsenruijter}, J. and {van der Feltz-Cornelis}, C.M. and P.F.M. Verhaak and R. Grol and M.J.P. Wensing",
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doi = "10.1186/1471-2296-15-35",
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Implementing guidelines for depression on antidepressant prescribing in general practice : A quasi-experimental evaluation. / Franx, G.; Huyser, F.G.; van der Koetsenruijter, J.; van der Feltz-Cornelis, C.M.; Verhaak, P.F.M.; Grol, R.; Wensing, M.J.P.

In: BMC Family Practice, Vol. 15, 35, 2014.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Implementing guidelines for depression on antidepressant prescribing in general practice

T2 - A quasi-experimental evaluation

AU - Franx, G.

AU - Huyser, F.G.

AU - van der Koetsenruijter, J.

AU - van der Feltz-Cornelis, C.M.

AU - Verhaak, P.F.M.

AU - Grol, R.

AU - Wensing, M.J.P.

PY - 2014

Y1 - 2014

N2 - BackgroundInternationally, 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.MethodsA 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.ResultsA 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).ConclusionsAn 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.Keywords: General practice, Guidelines, Antidepressants, Implementation, Stepped care

AB - BackgroundInternationally, 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.MethodsA 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.ResultsA 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).ConclusionsAn 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.Keywords: General practice, Guidelines, Antidepressants, Implementation, Stepped care

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JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

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