Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial

Objective. Depressive disorders are of great medical and political significance.Although evidence-based guidelines have been published and educationalinitiatives have been launched to implement them, they are rarelyactually used. The aim of the study was to implement clinicalpractice guidelines for outpatient care of depression usinga practice-oriented and interdisciplinary approach. Design. Controlled clinical trial with a naturalistic design (data collectionwithin routine practice) designed as a prospective pre-poststudy. Setting. Outpatient care. Participants. 29 general practitioners (intervention: 18; control: 11) and15 psychiatrists (intervention: 11; control: 4). Overall, thetreatment of 698 patients (two samples: pre: 361; post: 337)was documented. Intervention(s). Multifaceted intervention combining benchmarking, continuousmedical education and interdisciplinary quality circles forthe diagnosis and treatment of depressive disorders. Main outcome measures. Mixed-effects regression models for cluster-adjusted analysisof patients' symptom reduction. Results. Although physicians in the intervention group improved theirclinical effectiveness (proportion of patients with response/remission)to a greater extent than physicians in the control group (intervention:48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysisfailed to prove a statistically significant effect of the interventionon the treatment outcome. Conclusions. Although no statistically significant improvements were foundregarding the outcomes, the action programme provides importantwork, materials and results for an integrated treatment modelfor depression.