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

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

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.

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.