HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tiemeier, H Articles by Rigter, H Search for Related Content PubMed PubMed Citation Articles by Tiemeier, H Articles by Rigter, H Topic Collections Relevant Article

Guideline adherence rates and interprofessional variation in a vignette study of depression

¹ Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
² RAND Europe, Leiden, The Netherlands
³ Dutch Institute for Health Care Improvement, Utrecht and Department of Social Medicine, University of Amsterdam, The Netherlands
⁴ Centre for Quality of Care Research, Nijmegen University – Maastricht University, The Netherlands

Correspondence to:
Dr H Tiemeier, Department of Epidemiology & Biostatistics, Erasmus Medical Centre Rotterdam, P O Box 1738, 3000 DR Rotterdam, The Netherlands;
tiemeier{at}epib.fgg.eur.nl Objective: To assess the appropriateness of and variation in intention-to-treat decisions in the management of depression in the Netherlands.

Design: Mailed survey with 22 paper cases (vignettes) based on a population study.

Setting: A random sample from four professional groups in the Dutch mental healthcare system.

Subjects: 264 general practitioners, psychiatrists, psychotherapists, and clinical psychologists.

Main outcome measures: Each vignette contained information on a number of patient characteristics taken from three national depression guidelines. The distribution of patient characteristics was based on data from a population study. Respondents were asked to choose the best treatment option and the best treatment setting. For each vignette we examined which of the selected treatments was appropriate according to the recommendations of the three published Dutch clinical guidelines and a panel of experts.

Results: 31% of all intention-to-treat decisions were not consistent with the guidelines. Overall, less severe depression, alcohol abuse, psychotic features, and lack of social resources were related to more inappropriate judgements. There was considerable variation between the professional groups: psychiatrists made more appropriate choices than the other professions although they had the highest rate of overtreatment.

Conclusions: There is sufficient variation in the intentions to treat depression to give it priority in quality assessment and guideline development. Efforts to achieve appropriate care should focus on treatment indications, referral patterns, and overtreatment.

Keywords: depression; guideline adherence; interprofessional variation

Relevant Article

ACTION POINTS

Tim Albert
Qual. Saf. Health Care 2002 11: 300. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				T. J. Schraufnagel, A. W. Wagner, J. Miranda, and P. P. Roy-Byrne Treating Minority Patients With Depression and Anxiety: What Does the Evidence Tell Us? Focus, September 1, 2008; 6(4): 517 - 527. [Abstract] [Full Text] [PDF]

				F. SCHNEIDER, M. HARTER, S. BRAND, P. SITTA, R. MENKE, U. HAMMER-FILIPIAK, R. KUDLING, A. HEINDL, K. HEROLD, U. FROMMBERGER, et al. Adherence to guidelines for treatment of depression in in-patients The British Journal of Psychiatry, November 1, 2005; 187(5): 462 - 469. [Abstract] [Full Text] [PDF]

				R Peveler Guideline adherence rates and interprofessional variation Qual. Saf. Health Care, September 1, 2002; 11(3): 208 - 208. [Full Text] [PDF]