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Background Since 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care. This study aims to investigate the effect of the introduction of the practice nurse mental health in general practices in the Netherlands on the number of diagnoses of chronic and acute alcohol abuse. Method The Netherlands Institute for Health Services Research (NIVEL) retrieved data of a representative sample of general practices (n = 155) for this study. Data were aligned at the starting point of the implementation of the PN-MH to compare the practices on our outcome measures after implementation of the PN-MH. Multilevel regression analyses were conducted to investigate differences in average number of chronic and acute alcohol abuse diagnoses between practices with a practice nurse mental health and control practices (without a practice nurse mental health and without a primary care psychologists). Results A significant decrease over time of chronic alcohol abuse diagnoses was observed (ß = -.52, p < 0.05) as well as a significant decrease over time of acute alcohol abuse diagnoses (ß = -.06, p < 0.05). After adjustment for multiple comparisons, no significant differences were found between practices that implemented a practice nurse mental health or only have a primary care psychologist and control practices. Practices that implemented a practice nurse mental health and have a primary care psychologist, had a higher mean of chronic and acute alcohol abuse diagnoses than control practices during all periods, but the differences between these groups were not statistically significant. Conclusions Based on the results of this study it seems that the introduction of practice nurses mental health in general practices is not associated with increased diagnoses of chronic or acute alcohol abuse.

OBJECTIVE: We conducted a clustered randomised controlled trial to study the effects of shared decision making (SDM) on patient recovery. This study aims to determine whether GPs trained in SDM and reinforcing patients' treatment expectations showed more trained behaviour during their consultations than untrained GPs.METHODS: We compared 86 consultations conducted by 23 trained GPs with 89 consultations completed by 19 untrained GPs. The primary outcomes were SDM, as measured by the OPTION scale, and positive reinforcement, as measured by global observation. Secondary outcomes were the level of autonomy in decision making and the duration of the consultation.RESULTS: Intervention consultations scored significantly higher on most elements of the OPTION scale, and on the autonomy scale; however, they were three minutes longer in duration, and the mean OPTION score of the intervention group remained below average.CONCLUSION: Training GPs resulted in more SDM behaviour and more autonomy for the patient; however, this increase is not attributable to the adoption of a patient perspective. Furthermore, while we aimed to demonstrate that SDM facilitates the reinforcement of patients' positive expectations, the measurement of this behaviour was not reliable.PRACTICE IMPLICATIONS: In supporting SDM, professionals should give greater attention to patients' treatment expectations.

Contains fulltext : 170672.pdf (publisher's version ) (Open Access)

Contains fulltext : 170672.pdf (publisher's version ) (Open Access)

Contains fulltext : 116623.pdf (publisher's version ) (Open Access), BACKGROUND: Inappropriate use of antidepressants (AD), defined as either continuation in the absence of a proper indication or continuation despite the lack of therapeutic efficacy, applies to approximately half of all long term AD users. METHODS/DESIGN: We have designed a cluster randomized controlled clinical trial to assess the (cost-) effectiveness of an antidepressant cessation advice in the absence of a proper indication for maintenance treatment with antidepressants in primary care.We will select all patients using antidepressants for over 9 months from 45 general practices. Patients will be diagnosed using the Composite International Diagnostic Interview (CIDI) version 3.0, extended with questions about the psychiatric history and previous treatment strategies. General practices will be randomized to either the intervention or the control group. In case of overtreatment, defined as the absence of a proper indication according to current guidelines, a cessation advice is given to the general practitioner. In the control groups no specific information is given. The primary outcome measure will be the proportion of patients that successfully discontinue their antidepressants at one-year follow-up. Secondary outcomes are dimensional measures of psychopathology and costs. DISCUSSION: This study protocol provides a detailed overview of the design of the trial. Study results will be of importance for refining current guidelines. If the intervention is effective it can be used in managed care programs. TRIAL REGISTRATION: NTR2032.

Item does not contain fulltext, Background: Revised guidelines for depression recommend a stepped care approach. Little is known about the implementation of the stepped care model by general practitioners (GPs) in daily practice. Objectives: To evaluate the performance of Dutch GPs in their general practice regarding important elements of the stepped care model (identification, severity assessment and stepped care treatment allocation) shortly before the revised Dutch multidisciplinary guideline for Depressive Disorders was published. Methods: Data was collected through a self-report questionnaire sent to 500 randomly selected GPs. Multivariate logistic regression analyses were employed to investigate whether GP-related characteristics were associated with GPs' self-reported performance. Results: The study involved 194 GPs (response rate: 39%). Responses indicated that 37% paid systematic attention to depression identification, 33% used a screening instrument, and 63% determined the severity of newly diagnosed depression, generally without using an instrument. Most GPs (72%) indicated to allocate stepped care treatment to the majority of their patients newly diagnosed with depression. However, more than 40% indicated to start with antidepressants, either alone or in combination with psychotherapy. Assessing the severity of newly diagnosed depression and clinical experience were positively associated with allocating stepped care treatment. Structural collaboration with mental health professionals was positively associated with assessing severity. Conclusion: Delivering stepped care for depression in daily general practice could be further improved. Collaboration with mental health professionals and routine severity assessment of diagnosed depression are positively associated with allocating stepped care.

Contains fulltext : 116623.pdf (publisher's version ) (Open Access), BACKGROUND: Inappropriate use of antidepressants (AD), defined as either continuation in the absence of a proper indication or continuation despite the lack of therapeutic efficacy, applies to approximately half of all long term AD users. METHODS/DESIGN: We have designed a cluster randomized controlled clinical trial to assess the (cost-) effectiveness of an antidepressant cessation advice in the absence of a proper indication for maintenance treatment with antidepressants in primary care.We will select all patients using antidepressants for over 9 months from 45 general practices. Patients will be diagnosed using the Composite International Diagnostic Interview (CIDI) version 3.0, extended with questions about the psychiatric history and previous treatment strategies. General practices will be randomized to either the intervention or the control group. In case of overtreatment, defined as the absence of a proper indication according to current guidelines, a cessation advice is given to the general practitioner. In the control groups no specific information is given. The primary outcome measure will be the proportion of patients that successfully discontinue their antidepressants at one-year follow-up. Secondary outcomes are dimensional measures of psychopathology and costs. DISCUSSION: This study protocol provides a detailed overview of the design of the trial. Study results will be of importance for refining current guidelines. If the intervention is effective it can be used in managed care programs. TRIAL REGISTRATION: NTR2032.

Item does not contain fulltext, Background: Revised guidelines for depression recommend a stepped care approach. Little is known about the implementation of the stepped care model by general practitioners (GPs) in daily practice. Objectives: To evaluate the performance of Dutch GPs in their general practice regarding important elements of the stepped care model (identification, severity assessment and stepped care treatment allocation) shortly before the revised Dutch multidisciplinary guideline for Depressive Disorders was published. Methods: Data was collected through a self-report questionnaire sent to 500 randomly selected GPs. Multivariate logistic regression analyses were employed to investigate whether GP-related characteristics were associated with GPs' self-reported performance. Results: The study involved 194 GPs (response rate: 39%). Responses indicated that 37% paid systematic attention to depression identification, 33% used a screening instrument, and 63% determined the severity of newly diagnosed depression, generally without using an instrument. Most GPs (72%) indicated to allocate stepped care treatment to the majority of their patients newly diagnosed with depression. However, more than 40% indicated to start with antidepressants, either alone or in combination with psychotherapy. Assessing the severity of newly diagnosed depression and clinical experience were positively associated with allocating stepped care treatment. Structural collaboration with mental health professionals was positively associated with assessing severity. Conclusion: Delivering stepped care for depression in daily general practice could be further improved. Collaboration with mental health professionals and routine severity assessment of diagnosed depression are positively associated with allocating stepped care.

Contains fulltext : 116623.pdf (publisher's version ) (Open Access), BACKGROUND: Inappropriate use of antidepressants (AD), defined as either continuation in the absence of a proper indication or continuation despite the lack of therapeutic efficacy, applies to approximately half of all long term AD users. METHODS/DESIGN: We have designed a cluster randomized controlled clinical trial to assess the (cost-) effectiveness of an antidepressant cessation advice in the absence of a proper indication for maintenance treatment with antidepressants in primary care.We will select all patients using antidepressants for over 9 months from 45 general practices. Patients will be diagnosed using the Composite International Diagnostic Interview (CIDI) version 3.0, extended with questions about the psychiatric history and previous treatment strategies. General practices will be randomized to either the intervention or the control group. In case of overtreatment, defined as the absence of a proper indication according to current guidelines, a cessation advice is given to the general practitioner. In the control groups no specific information is given. The primary outcome measure will be the proportion of patients that successfully discontinue their antidepressants at one-year follow-up. Secondary outcomes are dimensional measures of psychopathology and costs. DISCUSSION: This study protocol provides a detailed overview of the design of the trial. Study results will be of importance for refining current guidelines. If the intervention is effective it can be used in managed care programs. TRIAL REGISTRATION: NTR2032.

Item does not contain fulltext, Background: Revised guidelines for depression recommend a stepped care approach. Little is known about the implementation of the stepped care model by general practitioners (GPs) in daily practice. Objectives: To evaluate the performance of Dutch GPs in their general practice regarding important elements of the stepped care model (identification, severity assessment and stepped care treatment allocation) shortly before the revised Dutch multidisciplinary guideline for Depressive Disorders was published. Methods: Data was collected through a self-report questionnaire sent to 500 randomly selected GPs. Multivariate logistic regression analyses were employed to investigate whether GP-related characteristics were associated with GPs' self-reported performance. Results: The study involved 194 GPs (response rate: 39%). Responses indicated that 37% paid systematic attention to depression identification, 33% used a screening instrument, and 63% determined the severity of newly diagnosed depression, generally without using an instrument. Most GPs (72%) indicated to allocate stepped care treatment to the majority of their patients newly diagnosed with depression. However, more than 40% indicated to start with antidepressants, either alone or in combination with psychotherapy. Assessing the severity of newly diagnosed depression and clinical experience were positively associated with allocating stepped care treatment. Structural collaboration with mental health professionals was positively associated with assessing severity. Conclusion: Delivering stepped care for depression in daily general practice could be further improved. Collaboration with mental health professionals and routine severity assessment of diagnosed depression are positively associated with allocating stepped care.

Item does not contain fulltext, BACKGROUND: Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. METHODS: Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. RESULTS: Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. LIMITATION: Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. CONCLUSIONS: Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.

PURPOSE: This study of Australian and Dutch people with anxiety or depressive disorder aims to examine people's perceived needs and barriers to care, and to identify possible similarities and differences. METHODS: Data from the Australian National Survey of Mental Health and Well-Being and the Netherlands Study of Depression and Anxiety were combined into one data set. The Perceived Need for Care Questionnaire was taken in both studies. Logistic regression analyses were performed to check if similarities or differences between Australia and the Netherlands could be observed. RESULTS: In both countries, a large proportion had unfulfilled needs and self-reliance was the most frequently named barrier to receive care. People from the Australian sample (N = 372) were more likely to perceive a need for medication (OR 1.8; 95% CI 1.3-2.5), counselling (OR 1.4; 95% CI 1.0-2.0) and practical support (OR 1.8; 95% CI 1.2-2.7), and people's overall needs in Australia were more often fully met compared with those of the Dutch sample (N = 610). Australians were more often pessimistic about the helpfulness of medication (OR 3.8; 95% CI 1.4-10.7) and skills training (OR 3.0; 95% CI 1.1-8.2) and reported more often financial barriers for not having received (enough) information (OR 2.4; 95% CI 1.1-5.5) or counselling (OR 5.9; 95% CI 2.9-11.9). CONCLUSIONS: In both countries, the vast majority of mental health care needs are not fulfilled. Solutions could be found in improving professionals' skills or better collaboration. Possible explanations for the found differences in perceived need and barriers to care are discussed; these illustrate the value of examining perceived need across nations and suggest substantial commonalities of experience across the two countries.

Item does not contain fulltext, BACKGROUND: Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. METHODS: Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. RESULTS: Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. LIMITATION: Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. CONCLUSIONS: Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.

Item does not contain fulltext, BACKGROUND: Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. METHODS: Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. RESULTS: Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. LIMITATION: Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. CONCLUSIONS: Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.

1 maart 2010, Contains fulltext : 87437.pdf (publisher's version ) (Closed access), BACKGROUND: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence. OBJECTIVE: To investigate how practice- and professional-related factors are associated with adherence to these guidelines. DESIGN: Cross-sectional cohort study. PARTICIPANTS: A total of 665 patients with a composite interview diagnostic instrument diagnosis of depressive or anxiety disorders, and 62 general practitioners from 21 practices participated. MEASURES: Actual care data were derived from electronic medical record data. The measurement of guideline adherence was based on performance indicators derived from evidence-based guidelines. Practice-, professional-, and patient-related characteristics were measured with questionnaires. The characteristics associated with guideline adherence were assessed by multivariate multilevel regression analysis. RESULTS: A number of practice and professional characteristics showed a significant univariate association with guideline adherence. The multivariate multilevel analyses revealed that, after controlling for patient characteristics, higher rates of guideline adherence were associated with stronger confidence in depression identification, less perceived time limitations, and less perceived barriers for guideline implementation. These professional-related determinants differed among the overall concept of guideline adherence and the various treatment options. CONCLUSIONS: This study showed that rates of adherence to guidelines on depressive and anxiety disorders were not associated with practice characteristics, but to some extent with physician characteristics. Although most of the identified professional-related determinants are very difficult to change, our results give some directions for improving depression and anxiety care.

Background: Little is known about the course and outcome of untreated anxiety and depression in patients with and without a self-perceived need for care. The aim of the present study was to examine the one-year course of untreated anxiety and depression, and to determine predictors of a poor outcome.Method: Baseline and one-year follow-up data were used of 594 primary care patients with current anxiety or depressive disorders at baseline (established by the Composite Interview Diagnostic Instrument (CIDI)), from the Netherlands Study of Depression and Anxiety (NESDA). Receipt of and need for care were assessed by the Perceived Need for Care Questionnaire (PNCQ).Results: In depression, treated and untreated patients with a perceived treatment need showed more rapid symptom decline but greater symptom severity at follow-up than untreated patients without a self-perceived mental problem or treatment need. A lower education level, lower income, unemployment, loneliness, less social support, perceived need for care, number of somatic disorders, a comorbid anxiety and depressive disorder and symptom severity at baseline predicted a poorer outcome in both anxiety and depression. When all variables were considered at the same time, only baseline symptom severity appeared to predict a poorer outcome in anxiety. In depression, a poorer outcome was also predicted by more loneliness and a comorbid anxiety and depressive disorder.Conclusion: In clinical practice, special attention should be paid to exploring the need for care among possible risk groups (e.g. low social economic status, low social support), and support them in making an informed decision on whether or not to seek treatment. © 2010 van Beljouw et al; licensee BioMed Central Ltd.

Objective: To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Design: Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Participants: Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners (GPs), were included. Measures: Diagnoses according to the Diagnostic and Statistic Manual of Mental Disorders, fourth edition (DSM-IV) were made using a structured and widely validated assessment. Socio-demographic and enabling characteristics, severity of symptoms, disability, (under treatment for) chronic somatic conditions, perceived need for care, beliefs and evaluations of care were measured by questionnaires. Actual care data were derived from electronic medical records. Criteria for guideline-concordant care were based on general practice guidelines, issued by the Dutch College of General Practitioners. Results: Two hundred and eighty-one (39%) patients received guideline-concordant care. High education level, accessibility of care, comorbidity of anxiety and depression, and severity and disability scores were positively associated with receiving guideline-concordant care in univariate analyses. In multivariate multi-level logistic regression models, significant associations with the clinical need factors disappeared. Positive evaluations of accessibility of care increased the chance (OR∈=∈1.31; 95%-CI∈=∈1.05-1.65; p∈=∈0.02) of receiving guideline-concordant care, as well as perceiving any need for medication (OR∈=∈2.99; 95%-CI∈=∈1.84-4.85; p∈<∈0.001), counseling (OR∈=∈2.25; 95%-CI∈=∈1. 29-3.95; p∈=∈0.005) or a referral (OR∈=∈1.83; 95%-CI∈=∈1.09-3.09; p∈=∈0.02). A low educational level decreased the odds (OR∈=∈0.33; 95%-CI∈=∈0.11-0.98; p∈=∈0.04) of receiving guideline-concordant care. Conclusions: This study shows that education level, accessibility of care

01 maart 2010, Contains fulltext : 87437.pdf (publisher's version ) (Closed access), BACKGROUND: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence. OBJECTIVE: To investigate how practice- and professional-related factors are associated with adherence to these guidelines. DESIGN: Cross-sectional cohort study. PARTICIPANTS: A total of 665 patients with a composite interview diagnostic instrument diagnosis of depressive or anxiety disorders, and 62 general practitioners from 21 practices participated. MEASURES: Actual care data were derived from electronic medical record data. The measurement of guideline adherence was based on performance indicators derived from evidence-based guidelines. Practice-, professional-, and patient-related characteristics were measured with questionnaires. The characteristics associated with guideline adherence were assessed by multivariate multilevel regression analysis. RESULTS: A number of practice and professional characteristics showed a significant univariate association with guideline adherence. The multivariate multilevel analyses revealed that, after controlling for patient characteristics, higher rates of guideline adherence were associated with stronger confidence in depression identification, less perceived time limitations, and less perceived barriers for guideline implementation. These professional-related determinants differed among the overall concept of guideline adherence and the various treatment options. CONCLUSIONS: This study showed that rates of adherence to guidelines on depressive and anxiety disorders were not associated with practice characteristics, but to some extent with physician characteristics. Although most of the identified professional-related determinants are very difficult to change, our results give some directions for improving depression and anxiety care.

Objective: To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Design: Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Participants: Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners (GPs), were included. Measures: Diagnoses according to the Diagnostic and Statistic Manual of Mental Disorders, fourth edition (DSM-IV) were made using a structured and widely validated assessment. Socio-demographic and enabling characteristics, severity of symptoms, disability, (under treatment for) chronic somatic conditions, perceived need for care, beliefs and evaluations of care were measured by questionnaires. Actual care data were derived from electronic medical records. Criteria for guideline-concordant care were based on general practice guidelines, issued by the Dutch College of General Practitioners. Results: Two hundred and eighty-one (39%) patients received guideline-concordant care. High education level, accessibility of care, comorbidity of anxiety and depression, and severity and disability scores were positively associated with receiving guideline-concordant care in univariate analyses. In multivariate multi-level logistic regression models, significant associations with the clinical need factors disappeared. Positive evaluations of accessibility of care increased the chance (OR∈=∈1.31; 95%-CI∈=∈1.05-1.65; p∈=∈0.02) of receiving guideline-concordant care, as well as perceiving any need for medication (OR∈=∈2.99; 95%-CI∈=∈1.84-4.85; p∈<∈0.001), counseling (OR∈=∈2.25; 95%-CI∈=∈1. 29-3.95; p∈=∈0.005) or a referral (OR∈=∈1.83; 95%-CI∈=∈1.09-3.09; p∈=∈0.02). A low educational level decreased the odds (OR∈=∈0.33; 95%-CI∈=∈0.11-0.98; p∈=∈0.04) of receiving guideline-concordant care. Conclusions: This study shows that education level, accessibility of care

Background: Little is known about the course and outcome of untreated anxiety and depression in patients with and without a self-perceived need for care. The aim of the present study was to examine the one-year course of untreated anxiety and depression, and to determine predictors of a poor outcome.Method: Baseline and one-year follow-up data were used of 594 primary care patients with current anxiety or depressive disorders at baseline (established by the Composite Interview Diagnostic Instrument (CIDI)), from the Netherlands Study of Depression and Anxiety (NESDA). Receipt of and need for care were assessed by the Perceived Need for Care Questionnaire (PNCQ).Results: In depression, treated and untreated patients with a perceived treatment need showed more rapid symptom decline but greater symptom severity at follow-up than untreated patients without a self-perceived mental problem or treatment need. A lower education level, lower income, unemployment, loneliness, less social support, perceived need for care, number of somatic disorders, a comorbid anxiety and depressive disorder and symptom severity at baseline predicted a poorer outcome in both anxiety and depression. When all variables were considered at the same time, only baseline symptom severity appeared to predict a poorer outcome in anxiety. In depression, a poorer outcome was also predicted by more loneliness and a comorbid anxiety and depressive disorder.Conclusion: In clinical practice, special attention should be paid to exploring the need for care among possible risk groups (e.g. low social economic status, low social support), and support them in making an informed decision on whether or not to seek treatment. © 2010 van Beljouw et al; licensee BioMed Central Ltd.

Contains fulltext : 79866.pdf (publisher's version ) (Closed access), OBJECTIVES: To assess professionals' adherence to evidence-based guidelines and to investigate whether or not this is influenced by recording of the diagnosis and symptom severity. METHOD: Analysis of baseline cross-sectional data of a cohort study of 721 primary care patients with a confirmed diagnosis of a depressive or anxiety disorder. Information on the management of depressive and anxiety disorders was gathered from the electronic medical patient records. Guideline adherence was measured by an algorithm, based on performance indicators. RESULTS: Forty-two percent of the patients with a depressive disorder was treated in accordance with the guideline, whereas 27% of the patients with an anxiety disorder received guideline-consistent care. The provision of care in line with current depression and anxiety guidelines was around 50% for persons with both types of disorders. Documentation of an International Classification of Primary Care diagnosis of depression or anxiety disorder appeared to have a strong influence on guideline adherence. Symptom severity, however, did not influence guideline adherence. CONCLUSIONS: Adherence to depression and anxiety guidelines can be improved, even when the general practitioner makes the diagnosis and records it. Data on actual health care delivery and quality of care provide insight and may be useful in developing quality improvement activities.

Contains fulltext : 79866.pdf (publisher's version ) (Closed access), OBJECTIVES: To assess professionals' adherence to evidence-based guidelines and to investigate whether or not this is influenced by recording of the diagnosis and symptom severity. METHOD: Analysis of baseline cross-sectional data of a cohort study of 721 primary care patients with a confirmed diagnosis of a depressive or anxiety disorder. Information on the management of depressive and anxiety disorders was gathered from the electronic medical patient records. Guideline adherence was measured by an algorithm, based on performance indicators. RESULTS: Forty-two percent of the patients with a depressive disorder was treated in accordance with the guideline, whereas 27% of the patients with an anxiety disorder received guideline-consistent care. The provision of care in line with current depression and anxiety guidelines was around 50% for persons with both types of disorders. Documentation of an International Classification of Primary Care diagnosis of depression or anxiety disorder appeared to have a strong influence on guideline adherence. Symptom severity, however, did not influence guideline adherence. CONCLUSIONS: Adherence to depression and anxiety guidelines can be improved, even when the general practitioner makes the diagnosis and records it. Data on actual health care delivery and quality of care provide insight and may be useful in developing quality improvement activities.

Contains fulltext : 69756.pdf (publisher's version ) (Closed access), BACKGROUND: Depression often occurs simultaneously with a variety of somatic, psychiatric, and social conditions. Knowledge about differences in the pharmacological treatment of depressed patients with and without co-morbidity is lacking. OBJECTIVE: To compare GPs' pharmacological treatment of depressed patients with and without co-morbidity. METHODS: Data were extracted from the computerized medical records of 77 general practices participating in the Dutch National Information Network of General Practice (LINH). We used diagnosis and prescription data of newly diagnosed depressed patients aged 18-65 years (n=4372). A mixed-model technique was used for analyzing the medical data. RESULTS: During the year after diagnosing depression, depressed patients who also suffered from chronic somatic or psychiatric morbidity were prescribed more psychotropics than patients with depression only. Prescription patterns of psychotropic drugs for depressed patients with and without co-morbid social problems differed only during the first 3 months after diagnosis. For the whole 1-year period after diagnosis, the pharmacological treatment of depression in patients with and without co-morbid social problems did not differ. CONCLUSION: Our results indicate that chronic somatic or psychiatric co-morbidity in depressed patients leads to higher GP prescription levels of psychotropics, whereas co-morbid social problems do not seem to influence GPs' pharmacological treatment decisions for depression.

Contains fulltext : 69756.pdf (publisher's version ) (Closed access), BACKGROUND: Depression often occurs simultaneously with a variety of somatic, psychiatric, and social conditions. Knowledge about differences in the pharmacological treatment of depressed patients with and without co-morbidity is lacking. OBJECTIVE: To compare GPs' pharmacological treatment of depressed patients with and without co-morbidity. METHODS: Data were extracted from the computerized medical records of 77 general practices participating in the Dutch National Information Network of General Practice (LINH). We used diagnosis and prescription data of newly diagnosed depressed patients aged 18-65 years (n=4372). A mixed-model technique was used for analyzing the medical data. RESULTS: During the year after diagnosing depression, depressed patients who also suffered from chronic somatic or psychiatric morbidity were prescribed more psychotropics than patients with depression only. Prescription patterns of psychotropic drugs for depressed patients with and without co-morbid social problems differed only during the first 3 months after diagnosis. For the whole 1-year period after diagnosis, the pharmacological treatment of depression in patients with and without co-morbid social problems did not differ. CONCLUSION: Our results indicate that chronic somatic or psychiatric co-morbidity in depressed patients leads to higher GP prescription levels of psychotropics, whereas co-morbid social problems do not seem to influence GPs' pharmacological treatment decisions for depression.

Contains fulltext : 51466.pdf (publisher's version ) (Closed access), BACKGROUND: Co-morbidity may influence GPs' treatment decisions for patients with anxiety. However, knowledge about differences in the pharmacological treatment of anxiety disorders in patients with and without co-morbidity is lacking. OBJECTIVE: To compare GPs' pharmacological treatment patterns for anxiety in patients with and without co-morbidity. METHODS: Data were extracted from computerized medical records of 77 general practices participating in the Dutch National Information Network of General Practice (LINH). We used diagnosis and prescription data of patients, aged 18-65 years, with a newly diagnosed anxiety disorder (n = 4604). A mixed model technique was used to determine if there was a difference in the pharmacological treatment of anxiety with and without co-morbidity. RESULTS: During the year after diagnosing anxiety, anxious patients who also suffered from chronic somatic morbidity or social problems were prescribed more benzodiazepines (effect size [ES] = 0.44, 95% confidence interval [CI] = 0.16-0.72 and ES = 0.67, 95% CI = 0.22-1.25, respectively) but no more antidepressants than patients with anxiety only. Compared to patients with a single diagnosis of anxiety, anxious patients who suffered simultaneously from other psychiatric conditions received twice as many antidepressant prescriptions (ES = 2.07, 95% CI = 1.89-2.56) as well as twice as many benzodiazepine prescriptions (ES = 1.98, 95% CI = 1.84-2.60) during the year after diagnosing anxiety. For all subgroups, the prescription rate of benzodiazepines remained high throughout the year after diagnosing anxiety. CONCLUSION: Our results indicate that psychiatric co-morbidity in anxious patients leads to higher prescription levels of both antidepressants and benzodiazepines. Chronic somatic co-morbidity and co-morbid social problems also lead to higher prescription levels of benzodiazepines, but does not seem to influence GPs' prescribing of antidepressants. The prescription pattern of benzodiaz

Contains fulltext : 52597.pdf (publisher's version ) (Closed access), OBJECTIVE: To describe the implementation of a nationwide programme and to determine the effects of specific quality improvement (QI) interventions within this programme on perceived barriers to collaboration between general practitioner (GPs) and mental health professionals and frequency of structural one-on-one contact regarding individual patients. METHODS: The implementation of regional QI-interventions, perceived barriers to collaboration, and frequency of structural one-on-one contact, were assessed in a cohort study involving two surveys (2001 and 2003) among a random sample of 2757 GPs. RESULTS: 1336 and 1358 GPs returned baseline and follow-up questionnaires respectively. Most of the interventions were only offered to a minority of GPs. Less than 25% of GPs that had been offered interventions actually participated. The frequency of structural one-on-one contact with mental health professionals did not change, but barriers to collaboration decreased between 2001 and 2003. For GPs who actually participated in interactive small group meetings or in intervention in which mental health professionals were integrated in general practice, a reduction of perceived barriers could be observed as well as an increase in the frequency of structural one-on-one contact. CONCLUSION: Interventions that could be characterized as interactive small group meetings as well as interventions that involved the integration of mental health professionals in general practice led to a reduction of perceived barriers as well as an increase in the frequency of structural one-on-one contact. These findings add to the knowledge of which interventions have an effect on the collaboration between different health care providers.

Contains fulltext : 52597.pdf (publisher's version ) (Closed access), OBJECTIVE: To describe the implementation of a nationwide programme and to determine the effects of specific quality improvement (QI) interventions within this programme on perceived barriers to collaboration between general practitioner (GPs) and mental health professionals and frequency of structural one-on-one contact regarding individual patients. METHODS: The implementation of regional QI-interventions, perceived barriers to collaboration, and frequency of structural one-on-one contact, were assessed in a cohort study involving two surveys (2001 and 2003) among a random sample of 2757 GPs. RESULTS: 1336 and 1358 GPs returned baseline and follow-up questionnaires respectively. Most of the interventions were only offered to a minority of GPs. Less than 25% of GPs that had been offered interventions actually participated. The frequency of structural one-on-one contact with mental health professionals did not change, but barriers to collaboration decreased between 2001 and 2003. For GPs who actually participated in interactive small group meetings or in intervention in which mental health professionals were integrated in general practice, a reduction of perceived barriers could be observed as well as an increase in the frequency of structural one-on-one contact. CONCLUSION: Interventions that could be characterized as interactive small group meetings as well as interventions that involved the integration of mental health professionals in general practice led to a reduction of perceived barriers as well as an increase in the frequency of structural one-on-one contact. These findings add to the knowledge of which interventions have an effect on the collaboration between different health care providers.

Contains fulltext : 51466.pdf (publisher's version ) (Closed access), BACKGROUND: Co-morbidity may influence GPs' treatment decisions for patients with anxiety. However, knowledge about differences in the pharmacological treatment of anxiety disorders in patients with and without co-morbidity is lacking. OBJECTIVE: To compare GPs' pharmacological treatment patterns for anxiety in patients with and without co-morbidity. METHODS: Data were extracted from computerized medical records of 77 general practices participating in the Dutch National Information Network of General Practice (LINH). We used diagnosis and prescription data of patients, aged 18-65 years, with a newly diagnosed anxiety disorder (n = 4604). A mixed model technique was used to determine if there was a difference in the pharmacological treatment of anxiety with and without co-morbidity. RESULTS: During the year after diagnosing anxiety, anxious patients who also suffered from chronic somatic morbidity or social problems were prescribed more benzodiazepines (effect size [ES] = 0.44, 95% confidence interval [CI] = 0.16-0.72 and ES = 0.67, 95% CI = 0.22-1.25, respectively) but no more antidepressants than patients with anxiety only. Compared to patients with a single diagnosis of anxiety, anxious patients who suffered simultaneously from other psychiatric conditions received twice as many antidepressant prescriptions (ES = 2.07, 95% CI = 1.89-2.56) as well as twice as many benzodiazepine prescriptions (ES = 1.98, 95% CI = 1.84-2.60) during the year after diagnosing anxiety. For all subgroups, the prescription rate of benzodiazepines remained high throughout the year after diagnosing anxiety. CONCLUSION: Our results indicate that psychiatric co-morbidity in anxious patients leads to higher prescription levels of both antidepressants and benzodiazepines. Chronic somatic co-morbidity and co-morbid social problems also lead to higher prescription levels of benzodiazepines, but does not seem to influence GPs' prescribing of antidepressants. The prescription pattern of benzodiaz

Contains fulltext : 52597.pdf (publisher's version ) (Closed access), OBJECTIVE: To describe the implementation of a nationwide programme and to determine the effects of specific quality improvement (QI) interventions within this programme on perceived barriers to collaboration between general practitioner (GPs) and mental health professionals and frequency of structural one-on-one contact regarding individual patients. METHODS: The implementation of regional QI-interventions, perceived barriers to collaboration, and frequency of structural one-on-one contact, were assessed in a cohort study involving two surveys (2001 and 2003) among a random sample of 2757 GPs. RESULTS: 1336 and 1358 GPs returned baseline and follow-up questionnaires respectively. Most of the interventions were only offered to a minority of GPs. Less than 25% of GPs that had been offered interventions actually participated. The frequency of structural one-on-one contact with mental health professionals did not change, but barriers to collaboration decreased between 2001 and 2003. For GPs who actually participated in interactive small group meetings or in intervention in which mental health professionals were integrated in general practice, a reduction of perceived barriers could be observed as well as an increase in the frequency of structural one-on-one contact. CONCLUSION: Interventions that could be characterized as interactive small group meetings as well as interventions that involved the integration of mental health professionals in general practice led to a reduction of perceived barriers as well as an increase in the frequency of structural one-on-one contact. These findings add to the knowledge of which interventions have an effect on the collaboration between different health care providers.

Contains fulltext : 52597.pdf (publisher's version ) (Closed access), OBJECTIVE: To describe the implementation of a nationwide programme and to determine the effects of specific quality improvement (QI) interventions within this programme on perceived barriers to collaboration between general practitioner (GPs) and mental health professionals and frequency of structural one-on-one contact regarding individual patients. METHODS: The implementation of regional QI-interventions, perceived barriers to collaboration, and frequency of structural one-on-one contact, were assessed in a cohort study involving two surveys (2001 and 2003) among a random sample of 2757 GPs. RESULTS: 1336 and 1358 GPs returned baseline and follow-up questionnaires respectively. Most of the interventions were only offered to a minority of GPs. Less than 25% of GPs that had been offered interventions actually participated. The frequency of structural one-on-one contact with mental health professionals did not change, but barriers to collaboration decreased between 2001 and 2003. For GPs who actually participated in interactive small group meetings or in intervention in which mental health professionals were integrated in general practice, a reduction of perceived barriers could be observed as well as an increase in the frequency of structural one-on-one contact. CONCLUSION: Interventions that could be characterized as interactive small group meetings as well as interventions that involved the integration of mental health professionals in general practice led to a reduction of perceived barriers as well as an increase in the frequency of structural one-on-one contact. These findings add to the knowledge of which interventions have an effect on the collaboration between different health care providers.

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