Adherence to guidelines for treatment of depression in in-patients.
BACKGROUND
Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment.


OBJECTIVE
To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines.


METHODS
We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge.


RESULTS
The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy.


CONCLUSIONS
The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.
Schneider
Frank
F
Department of Psychiatry and Psychotherapy, University of Aachen RWTH, Pauwelsstrasse 30, 52074 Aachen, Germany. fschneider@ukaachen.de
Härter
Martin
M
Brand
Silke
S
Sitta
Petra
P
Menke
Ralph
R
Hammer-Filipiak
Ursula
U
Kudling
Ralf
R
Heindl
Andrea
A
Herold
Kurt
K
Frommberger
Ulrich
U
Elmer
Olivier
O
Hetzel
Günter
G
Witt
Gabriele
G
Wolfersdorf
Manfred
M
Berger
Mathias
M
Gaebel
Wolfgang
W
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004334:Drug Administration Schedule; D004565:Electroconvulsive Therapy / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D016896:Treatment Outcome
D000928:Antidepressive Agents