Background: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a... Show moreBackground: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence. Objective: To investigate how practice- and professional-related factors are associated with adherence to these guidelines. Design: Cross-sectional cohort study. Participants: A total of 665 patients with a composite interview diagnostic instrument diagnosis of depressive or anxiety disorders, and 62 general practitioners from 21 practices participated. Measures: Actual care data were derived from electronic medical record data. The measurement of guideline adherence was based on performance indicators derived from evidence-based guidelines. Practice-, professional-, and patient-related characteristics were measured with questionnaires. The characteristics associated with guideline adherence were assessed by multivariate multilevel regression analysis. Results: A number of practice and professional characteristics showed a significant univariate association with guideline adherence. The multivariate multilevel analyses revealed that, after controlling for patient characteristics, higher rates of guideline adherence were associated with stronger confidence in depression identification, less perceived time limitations, and less perceived barriers for guideline implementation. These professional-related determinants differed among the overall concept of guideline adherence and the various treatment options. Conclusions: This study showed that rates of adherence to guidelines on depressive and anxiety disorders were not associated with practice characteristics, but to some extent with physician characteristics. Although most of the identified professional-related determinants are very difficult to change, our results give some directions for improving depression and anxiety care. Show less
Beljouw, I. van; Verhaak, P.; Prins, M.; Cuijpers, P.; Penninx, B.; Bensing, J. 2010
Objectives: This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of... Show moreObjectives: This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of patients-three that did not receive treatment for different reasons (no problem perceived, no perceived need for care, and unmet need for care) and one that received treatment-regarding their predisposing, enabling, and need factors. Methods: Cross-sectional data were used for 743 primary care patients with current anxiety or depressive disorder from the Netherlands Study of Depression and Anxiety (NESDA). Diagnoses were confirmed with the Composite International Diagnostic Interview. Patients' perception of the presence of a mental problem, perceived need for care, service utilization, and reasons for not receiving treatment were assessed with the Perceived Need for Care Questionnaire. Results: Forty-three percent of the respondents with a six-month anxiety or depression diagnosis did not receive treatment. Twenty-one percent of all respondents with depression or anxiety expressed a need for care but did not receive any. Preferring to manage the problem themselves was the most common reason for respondents to avoid seeking treatment. There were no significant differences in clinical need factors between treated patients and untreated patients with a perceived need for care. Compared with patients in the other two untreated groups, untreated patients with a perceived need for care were more hindered in regard to symptom severity, functional disability, and psychosocial functioning. Conclusions: General practitioners should pay considerable attention to patients whose need for care is unmet. Furthermore, findings support the implementation of patient empowerment in mental health care in order to contribute to easily accessible and patient-centered care. (Psychiatric Services 61: 250-257, 2010) Show less
The aim of this study was to validate the Dutch version of the Kessler-10 (K10) as well as an extended version (EK10) in screening for depressive and anxiety disorders in primary care. Data are... Show moreThe aim of this study was to validate the Dutch version of the Kessler-10 (K10) as well as an extended version (EK10) in screening for depressive and anxiety disorders in primary care. Data are from 1607 participants (18 through 65 years, 68.8% female) of the Netherlands Study of Depression and Anxiety (NESDA), recruited from 65 general practitioners. Participants completed the K10, extended with five additional questions focusing on core anxiety symptoms, and were evaluated with the WHO Composite International Diagnostic Interview (CID! lifetime version 2.1) to assess DSM-IV disorders (major depressive disorder, dysthymia, generalized anxiety disorder, social phobia, panic disorder, agoraphobia). Reliability (Cronbach's a) of the Dutch K10 was 0.94. Based on Receiver Operating Characteristics (ROC) analysis, the area under the curve (AUC) for the K10 for any depressive and/or anxiety disorder was found to be 0.87. The extended questions on the EK10 significantly improved the detection of anxiety disorders in particular. With a cut-off point of 20, the K10 reached a sensitivity of 0.80 and a specificity of 0.81 for any depressive and/or anxiety disorder. For the EK10, a cut-off point of 20 and/or at least one positive answer on the additional questions provided a sensitivity of 0.90 and a specificity of 0.75 for detecting any depressive and/or anxiety disorder. The Dutch version of the K10 is appropriate for screening depressive disorders in primary care, while the EK10 is preferred in screening for both depressive and anxiety disorders. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Show less
