Effectiveness of a Breakthrough Collaborative aimed at the implementation of depression guidelines in primary and secondary care.

Depression is a growing problem in terms of suffering and care utilization. Two
depression guidelines contain recommendations about the use of effective
interventions in Dutch mental health. There is a gap between guidelines and
daily practice. One of the problems is the prescription of antidepressants to a
broad group of patients, unrelated to the severeness of symptoms. The
Breakthrough method is a promising guideline implementation strategy, but has
not been evaluated in Dutch mental health. Some lessons can be learned from a
pilot project actually being effectuated by the Trimbos-institute and the CBO.

A second large scale Depression Collaborative will start in december 2006. This
study is and evaluation of the break through method in Dutch mental health.
Results are of interest to implementation experts and researchers within and
outside mental health, as well as to policy makers and financers of this type
of projects. Results will be spread from 2008 onwards during an invitational
conference and in the scientific literature, as part of a PhD programme.

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 additional burden in this reasearch caused to patients is limited and
consist of 1 interview and 1 questionaire at inclusion and 1 questionaire at
follow-up after 1 year.

The burden for health care providers is limited to some questionaires during
the course of the project, and participation in a group and/or individual
interview.