The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands.
BACKGROUND
In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands.


OBJECTIVE
Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its implementation in the primary care setting in the Netherlands.


METHODS
Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, information sheets from professional associations.


RESULTS
Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN) in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients.


CONCLUSIONS
Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.
de Jong
Fransina J
FJ
Research Program Diagnosis and Treatment, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands; Department of General Practice and Institute for Research in Extramural Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
van Steenbergen-Weijenburg
Kirsten M
KM
Huijbregts
Klaas M L
KM
Vlasveld
Moniek C
MC
Van Marwijk
Harm W J
HW
Beekman
Aartjan T F
AT
van der Feltz-Cornelis
Christina M
CM