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