title: Insufficient depression treatment in outpatient settings.
abstract: BACKGROUND
  The present status of outpatient treatment of depression in Germany was evaluated with respect to the adherence of general practitioners (GPs) and specialists of psychiatry to clinical practice guidelines.
  
  
  METHODS
  In total, 488 depressed patients' psychopathology, diagnostic assessment, therapeutic measures and referral frequency were documented at inclusion into study by 43 general practitioners and 23 specialists of psychiatry in three regions of Germany. The investigation of change in depressive symptoms after six to eight weeks by means of self-assessment could be evaluated for 165 patients.
  
  
  RESULTS
  The results of diagnostic assessment demonstrated that diagnoses of depression were not always based on the diagnostic criteria for depression (ICD-10): 33% of GPs' and 17% of specialists' patients were included as depressed patients into the study despite not fulfilling the ICD-10 criteria in the standardized documentation. Therapeutic undertreatment was more often found in the group of GPs. Referrals were found not to be oriented towards guidelines. After six to eight weeks, one half of patients reported a reduction in depressed symptoms, the other half of patients reported a stagnation or even a progression.
  
  
  CONCLUSIONS
  The study has shown that physicians in outpatient settings still fail to orient themselves towards guideline recommendations. This reflects the need for physicians to receive guideline training, with the aim of improving the quality of care for depression. A quality management intervention program consisting of guideline training and an interdisciplinary quality circle to improve depression treatment and networking was supported by the authors and is currently being evaluated.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Aachen, Germany. fschneider@ukaachen.de
authors.forename: Frank
authors.initials: F
authors.lastname: Schneider
authors.forename: Sandra
authors.initials: S
authors.lastname: Kratz
authors.forename: Isaac
authors.initials: I
authors.lastname: Bermejo
authors.forename: Ralph
authors.initials: R
authors.lastname: Menke
authors.forename: Christoph
authors.initials: C
authors.lastname: Mulert
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaebel
authors.forename: Martin
authors.initials: M
authors.lastname: Härter
references.citation: Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:9-15
references.pmid: 14710664
references.citation: JAMA. 1999 Sep 1;282(9):867-74
references.pmid: 10478694
references.citation: Am J Psychiatry. 1997 Jun;154(6 Suppl):59-65
references.pmid: 9167546
references.citation: Arch Gen Psychiatry. 1996 Oct;53(10):924-32
references.pmid: 8857869
references.citation: J Gen Intern Med. 2000 May;15(5):284-92
references.pmid: 10840263
references.citation: Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:36-43
references.pmid: 14710666
references.citation: Arch Fam Med. 1999 Jan-Feb;8(1):58-67
references.pmid: 9932074
references.citation: Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:50-6
references.pmid: 14710668
references.citation: Nervenarzt. 2001 Jul;72(7):521-8
references.pmid: 11478223
references.citation: Arch Gen Psychiatry. 1998 Dec;55(12):1121-7
references.pmid: 9862556
references.citation: Bull World Health Organ. 2000;78(4):413-26
references.pmid: 10885160
references.citation: Arch Fam Med. 1995 Feb;4(2):99-105
references.pmid: 7842160
references.citation: J Clin Psychiatry. 1993 Feb;54 Suppl:4-8; discussion 9
references.pmid: 8444833
references.citation: JAMA. 1999 Nov 10;282(18):1737-44
references.pmid: 10568646
references.citation: Z Arztl Fortbild Qualitatssich. 2000 Jan;94(1):21-30
references.pmid: 10721161
references.citation: Epidemiol Rev. 1995;17(1):182-90
references.pmid: 8521936
references.citation: West J Med. 2000 Feb;172(2):133-7
references.pmid: 10693379
references.citation: Lancet. 2000 Jan 15;355(9199):185-91
references.pmid: 10675118
references.citation: Br J Gen Pract. 1995 Dec;45(401):643-7
references.pmid: 8745861
references.citation: J Clin Psychiatry. 1999 Mar;60(3):142-56
references.pmid: 10192589
references.citation: Am J Psychiatry. 1999 Jan;156(1):115-23
references.pmid: 9892306
references.citation: Hum Psychopharmacol. 2002 Jun;17 Suppl 1:S1-11
references.pmid: 12404663
references.citation: JAMA. 1995 Nov 15;274(19):1511-7
references.pmid: 7474219
references.citation: Am J Psychiatry. 2000 Apr;157(4 Suppl):1-45
references.pmid: 10767867
references.citation: JAMA. 1994 Dec 14;272(22):1749-56
references.pmid: 7966923
references.citation: J Gen Intern Med. 1995 Dec;10(12):663-70
references.pmid: 8770718
references.citation: N Engl J Med. 1999 Oct 28;341(18):1329-35
references.pmid: 10536124
references.citation: Arch Gen Psychiatry. 1998 Jul;55(7):645-51
references.pmid: 9672056
references.citation: J Gen Intern Med. 1999 Sep;14(9):569-80
references.pmid: 10491249
references.citation: Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:67-73
references.pmid: 14710670
references.citation: Med J Aust. 2000 Jul 17;173(2):106-10
references.pmid: 10937041