Insufficient depression treatment in outpatient settings.
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.
Schneider
Frank
F
Department of Psychiatry and Psychotherapy, University of Aachen, Germany. fschneider@ukaachen.de
Kratz
Sandra
S
Bermejo
Isaac
I
Menke
Ralph
R
Mulert
Christoph
C
Hegerl
Ulrich
U
Berger
Mathias
M
Gaebel
Wolfgang
W
Härter
Martin
M
Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:9-15
14710664
JAMA. 1999 Sep 1;282(9):867-74
10478694
Am J Psychiatry. 1997 Jun;154(6 Suppl):59-65
9167546
Arch Gen Psychiatry. 1996 Oct;53(10):924-32
8857869
J Gen Intern Med. 2000 May;15(5):284-92
10840263
Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:36-43
14710666
Arch Fam Med. 1999 Jan-Feb;8(1):58-67
9932074
Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:50-6
14710668
Nervenarzt. 2001 Jul;72(7):521-8
11478223
Arch Gen Psychiatry. 1998 Dec;55(12):1121-7
9862556
Bull World Health Organ. 2000;78(4):413-26
10885160
Arch Fam Med. 1995 Feb;4(2):99-105
7842160
J Clin Psychiatry. 1993 Feb;54 Suppl:4-8; discussion 9
8444833
JAMA. 1999 Nov 10;282(18):1737-44
10568646
Z Arztl Fortbild Qualitatssich. 2000 Jan;94(1):21-30
10721161
Epidemiol Rev. 1995;17(1):182-90
8521936
West J Med. 2000 Feb;172(2):133-7
10693379
Lancet. 2000 Jan 15;355(9199):185-91
10675118
Br J Gen Pract. 1995 Dec;45(401):643-7
8745861
J Clin Psychiatry. 1999 Mar;60(3):142-56
10192589
Am J Psychiatry. 1999 Jan;156(1):115-23
9892306
Hum Psychopharmacol. 2002 Jun;17 Suppl 1:S1-11
12404663
JAMA. 1995 Nov 15;274(19):1511-7
7474219
Am J Psychiatry. 2000 Apr;157(4 Suppl):1-45
10767867
JAMA. 1994 Dec 14;272(22):1749-56
7966923
J Gen Intern Med. 1995 Dec;10(12):663-70
8770718
N Engl J Med. 1999 Oct 28;341(18):1329-35
10536124
Arch Gen Psychiatry. 1998 Jul;55(7):645-51
9672056
J Gen Intern Med. 1999 Sep;14(9):569-80
10491249
Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:67-73
14710670
Med J Aust. 2000 Jul 17;173(2):106-10
10937041