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Open Access Research article

Implementing guidelines for depression on antidepressant prescribing in general practice: a quasi-experimental evaluation

Gerdien Franx1*, Jochanan Huyser2, Jan Koetsenruijter3, Christina M van der Feltz-Cornelis145, Peter FM Verhaak67, Richard PTM Grol3 and Michel Wensing3

Author Affiliations

1 Trimbos Institute, Netherlands institute of mental health and addiction, PO Box 725, 3500 AS Utrecht, the Netherlands

2 Arkin, PO Box 75848, 1070 AV Amsterdam, the Netherlands

3 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114, 6500 HB Nijmegen, the Netherlands

4 Tilburg University, Tranzo, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE Tilburg, the Netherlands

5 Clinical Centre for Body, Mind and Health, GGz Breburg, PO Box 770, 5000 AT Tilburg, the Netherlands

6 Nivel, Netherlands institute for health services research, PO Box 1568, 3500 BN Utrecht, the Netherlands

7 Rijksuniversiteit Universiteit Groningen, University Medical Centre Groningen, dep. General Practice, PO Box 196, FA20, 9700 AD Groningen, the Netherlands

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BMC Family Practice 2014, 15:35  doi:10.1186/1471-2296-15-35

Published: 19 February 2014

Abstract

Background

Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general practice as a first treatment step are considered to be high. The aim of this study was to evaluate the implementation of guideline recommendations on antidepressant prescribing.

Methods

A quasi-experimental study with a non-equivalent naturalistic control group and three years follow-up was performed in the general practice setting in the Netherlands. General Practitioners (GPs) participated in a national Quality Improvement Collaborative (QIC), focusing on the implementation of a guideline based model for a stepped care approach to depression. The model consisted of self-help and psychological treatment options for patients with milder symptoms as an alternative to antidepressants in general practice. Changes in antidepressant prescription rates of GPs were documented for a three-year period and compared to those in a control group of GPs, selected from an ongoing national registration network.

Results

A decrease of 23.3% (49.4%-26.1%) in antidepressant prescription rates for newly diagnosed patients with depressive symptoms was found within the intervention group, whereas no difference occurred in the reference group (50.3%-52.6%). The decrease over time was significant, compared to the usual care group (OR 0.44, 95% CI: 0.21-0.92).

Conclusions

An implementation program using stepped care principles for the allocation of depression interventions resulted in reduced antidepressant prescription rates in general practice. GPs can change prescribing behaviour within the context of a QIC.

Keywords:
General practice; Guidelines; Antidepressants; Implementation; Stepped care