Stepped Care and e-Health: Practical Applications to Behavioral Disorders


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Archives of Women's Mental Health. Sexual Dysfunction Encyclopedia of Stress. Journal of Clinical Psychology in Medical Settings. The unmet educational agenda in integrated care. Behavioral approaches to chronic disease in adolescence: A guide to integrative care Behavioral Approaches to Chronic Disease in Adolescence: a Guide to Integrative Care.

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Introduction: Clinician's handbook of evidence-based practice guidelines: The role of practice guidelines in systematic quality improvement Practitioner's Guide to Evidence-Based Psychotherapy. Practitioner's guide to evidence-based psychotherapy Practitioner's Guide to Evidence-Based Psychotherapy. The predoctoral internship: Is current training anachronistic? Professional Psychology: Research and Practice. Managing psychosocial issues in a primary care setting Drug Benefit Trends. Hume's psychology, contemporary learning theory, and the problem of knowledge amplification New Ideas in Psychology.

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Marleen LM Hermens: ln. Received Apr 26; Accepted Dec This article has been cited by other articles in PMC.

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Abstract Background Depression is a common mental disorder with a high burden of disease which is mainly treated in primary care. Methods Optimal care was operationalised by indicators covering the entire continuum of depression care: from prevention to chronic depression. Results Six GPs and 22 other mostly primary mental health care providers participated. Conclusions The management of depression in primary care seems in line with stepped care principles, although it can be improved by applying more elements of a stepped care approach.

Background Depression is a common mental disorder. Methods Study design and selection of participants Considering the exploratory nature of the study aims, a predominantly qualitative approach was adopted to examine thoroughly the depression care as provided by a sample of GPs and the mental health care professionals they collaborated with.

Table 1 Indicators covering five areas of depression care.

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Indicators I Early recognition and indicated prevention 1. Diagnosis and symptom severity 3. Providing stepped care treatment 3. Open in a separate window. Indicator that was developed for this study. Data collection methods The indicators served as the basis for data collection using a mix of research methods. Individual interviews with the GPs For the semi-structured individual interviews, an interview guide was prepared, based on the eleven indicators of optimal depression care. Self-assessment questionnaire for the GPs The self-assessment questionnaire covered questions on all eleven indicators of optimal depression care.

Data analysis The semi-structured interviews were audiotaped and notes were taken. Table 2 Characteristics of the GPs and their practices.

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Research question 1: Is there a gap between routine care and optimal care? Table 3 Results of the self-assessment questionnaire for GPs on eleven indicators of optimal care. Research question 2: What factors influenced the delivery of optimal care? Table 4 Summary of facilitators and barriers to optimal care for depression. The improvement potential in areas I-V according to the GPs In the self-assessment questionnaire, and also in the interviews, most GPs indicated that the quality of care for depressed patients could be improved mostly by the strengthening of primary mental health care.

All participating GPs were dissatisfied with the information sharing by secondary mental health care regarding referred patients, except for one GP: GP6: The discharge letter contains advice about the treatment, but also advice that was given to the patient. Discussion Main findings On the one hand, the results can be interpreted to mean that the GPs and their primary care colleagues embraced the concept of a general stepped care approach in the care for depressed patients.

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Strengths and limitations A strength of our study is that we investigated the whole continuum of depression care, from prevention of depression to chronic depression care. Relation to existing literature Some findings of this study have, to our knowledge, never been reported before. Recommendations Strengthening primary care is high on the agenda of many western countries. Conclusion The management of depression in Dutch primary care, as reported by clinicians, seems in line with stepped care principles, although it can be further improved by applying more elements.

Competing interests The authors declare that they have no competing interests. Acta Psychiatr Scand. Comparing the effects on work performance of mental and physical disorders. Soc Psychiatry Psychiatr Epidemiol. Cost of disorders of the brain in Europe Eur Neuropsychopharmacol. Differences in lifetime use of services for mental health problems in six European countries. Psychiatr Serv. Mental health care as delivered by Dutch general practitioners between and Scand J Prim Health Care. Cijfers uit de registratie van huisartsen. Peiling [Data from the registration of general practitioners in ] Utrecht: Nivel [in Dutch]; Integrating mental health into primary care: a global perspective.

Geneva: World Health Organization; Multidisciplinaire richtlijn depressie tweede revisie. Identification of common mental disorders and management of depression in primary care. Wellington: New Zealand Guidelines Group; Depression: the treatment and management of depression in adults. NICE clinical guideline Diagnostic and statistical manual of mental disorders, 4th ed, text revision.

Delivering stepped care: an analysis of implementation in routine practice. Implement Sci. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry. How well do GPs fulfill their educator role in consultations for depression and anxiety?

Patient Educ Couns. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. GP treatment decisions for patients with depression: an observational study. Br J Gen Pract. Deciding who gets treatment for depression and anxiety: a study of consecutive GP attenders.

References

Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting. Implementing a stepped-care approach in primary care: results of a qualitative study. Implementation Sci. What drives change? Barriers to and incentives for achieving evidence-based practice.

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Kernset prestatie-indicatoren — geestelijke gezondheidszorg en verslavingszorg [Core set of performance indicators - mental health and addiction] Den Haag: Vijfkeerblauw [in Dutch]; The four-dimensional symptom questionnaire 4DSQ : A validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization.

BMC Psychiatry. Delivering stepped care for depression in general practice: results of a survey amongst general practitioners in the Netherlands. Eur J Gen Practice. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. J Gen Intern Med.

Barriers in recognising, diagnosing and managing depressive and anxiety disorders as experienced by Family Physicians; a focus group study. Aust J Rural Health. Collaboration between general practitioners GPs and mental health care professionals within the context of reforms in Quebec. Ment Health Fam Med. Support Center Support Center.

Stepped Care and e-Health: Practical Applications to Behavioral Disorders Stepped Care and e-Health: Practical Applications to Behavioral Disorders
Stepped Care and e-Health: Practical Applications to Behavioral Disorders Stepped Care and e-Health: Practical Applications to Behavioral Disorders
Stepped Care and e-Health: Practical Applications to Behavioral Disorders Stepped Care and e-Health: Practical Applications to Behavioral Disorders
Stepped Care and e-Health: Practical Applications to Behavioral Disorders Stepped Care and e-Health: Practical Applications to Behavioral Disorders
Stepped Care and e-Health: Practical Applications to Behavioral Disorders Stepped Care and e-Health: Practical Applications to Behavioral Disorders

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