title: Assessing adherence to guidelines with administrative data in psychiatric outpatients.
abstract: OBJECTIVE
  To assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders using administrative data.
  
  
  METHODS
  In a retrospective cohort study, we analysed routinely collected administrative data of 5346 patients, treated for mood, anxiety or somatoform disorders with pharmacotherapy, psychotherapy or a combination of both. Available administrative data allowed assessment of guideline adherence with a disorder-independent set of five quality indicators, assessing psychotherapy, pharmacotherapy, a combination of both and routine outcome measurements (ROM) during diagnostic and therapeutic phases. Associations between the socio-demographic variables age, gender, clinical diagnosis and treatment type on the one hand and non-adherence to guidelines were tested using logistic regression analysis.
  
  
  RESULTS
  Patients were aged 39.5 years (SD 13.0) on average. The majority of patients were treated with a combination of pharmacotherapy and psychotherapy (50.1%), followed by psychotherapy (44.2%) and pharmacotherapy (5.6%). The majority of patients were suffering from a mood disorder (50.0%), followed by anxiety (43.9%) and somatoform disorders (6.1%). A diagnosis of anxiety or somatoform disorder was associated with higher odds of suboptimal duration [odds ratio (OR): 1.55 and 1.82[ and suboptimal frequency of psychotherapeutic treatment (OR of 0.89 and 0.63), and absence of ROM in the diagnostic phase (ORs 1.31 and 1.36, respectively) compared with depressive disorders. No ROM in the diagnostic phase was also predicted for by increasing age (ORs for the age categories of 56 and older of 1.48).
  
  
  CONCLUSIONS
  In this proof of principal study, we were able to assess some key indicators assessing adherence to clinical guidelines by using administrative data. Also, we could identify predictors of adherence with simple parameters available in every administrative data. Administrative data could help to monitor and aid guideline adherence in routine care, although quality may vary between settings.
authors.affiliation: Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: van Fenema
authors.affiliation: Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Giltay
authors.affiliation: Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: van Noorden
authors.affiliation: Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: van Hemert
authors.affiliation: Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Zitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D019964:Mood Disorders / Q000628:therapy; D009426:Netherlands; D010045:Outpatients; D017410:Practice Guidelines as Topic / Q000592:standards*; D011619:Psychotropic Drugs / Q000627:therapeutic use; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012737:Sex Factors; D013001:Somatoform Disorders / Q000628:therapy; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: evaluation; evidence-based medicine