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ID
Source
Brief title
Health condition
depression, implementation, guidelines, collaboratives
depressie, implementatie, richtlijnen
Sponsors and support
ZonMw
Intervention
Outcome measures
Primary outcome
Outcomes are on the professional, organisational and on the patient level.
1. The primary outcome measure of professional performance is:
a. A reduction of antidepressants prescription for patients with non-severe depression (reduction of overtreatment);
2. The primary outcome measure of organisational performance is:
a. A reduction of the waiting time to specialised depression treatment for patients with severe or long term depression (reduction of undertreatment);
3. The primary outcome measures on the patient level are:
a. A reduction in depressive symptoms and an improvement in disability status (effectiveness).
Secondary outcome
Secondary measures are:
1. Professional performance: satisfaction with collaboration, patient education delivered;
2. Organisational level: monitoring system in use;
3. Patient level outcomes: care consumption, satisfaction with care.
Background summary
This study aims at gathering conclusive information about the effectiveness and efficiency of the second
Depression Breakthrough Collaborative and to make the results useful to other implementation
programs.
This study aims to answer the following central questions:
1 .Does a Depression Breakthrough Collaborative lead to better adherence to guidelines with better outcomes for patients compared to care as usual?
2.Does implementing guidelines with the Breakthrough Method lead to more efficient health care compared to care as usual?
3. What are the implementation activities and experiences of the improvement teams and what barriers and facilitators for successful implementation can be identified? The design is a quasi-experimental trial, consisting of a systematic measurement of patient outcomes (depression symptoms and functional status) and care provided by practitioners (antidepressant prescription, monitoring) of the new Depression Collaborative. Outcomes are compared to care as usual
delivered by a control group of primary and specialty mental health practitioners from the NESDA cohort study (ZonMw/GeestKracht consortium Depression). The design of the economic evaluation is a cost-effectiveness study. (In-)direct health care cost as well as implementation costs are included. Additional information about the implementation processes is gathered using mainly qualitative methods. The intervention group consists of mental health workers and their patients aged 18-65 diagnosed with depression.
Results are published in 2009/2010
Study objective
Implementation of innovations in mental health care needs multifaceted strategies in order to improve care with better outcomes for patients. The hypothesis in this study is: teams of health care professionals participating in a Breakthrough Depression Project implement national guidelines to a higher degree with better outcomes for patients than a control group of health care professionals and their patients receiving care as usual.
Intervention
The intervention group receives depression care according to guidelines, the control group receives care as usual. Depression care according to guidelines concerns a series of effective interventions, in a specific order. According to this stepped care principle patients start at the lowest level of treatment from which effect can be expected in order to step up to a more intense level of treatment, when the first step has not generated the expected effect within a number of weeks. The levels of treatment consist of one of more of the following interventions: information, psycho-education, individual or group selfhelp course, running therapy, problem solving treatment or brief psychotherapeutic interventions, antidepressants, psychotherapy (cognititve therapy, cognitive behavioral therapy, interpersonal psychotherapy). Stepped care assumes that depression symptoms are being monitored. In the intervention group a Beck Depression Inventory will be administered every 6 weeks until the score is under 10.
Inclusion criteria
1. Aged 18-65;
2. Sufficient Dutch language skills.
Exclusion criteria
1. Aged younger than 18 and older than 65;
2. Insufficient Dutch langauage skills
Design
Recruitment
Followed up by the following (possibly more current) registration
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Other (possibly less up-to-date) registrations in this register
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In other registers
| Register | ID |
|---|---|
| NTR-new | NL875 |
| NTR-old | NTR889 |
| Other | : N/A |
| ISRCTN | ISRCTN99634826 |