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Randomized Controlled Trial
. 2007 Mar 1:7:34.
doi: 10.1186/1472-6963-7-34.

Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

Marjoliek A IJff  1 , Klaas M L Huijbregts, Harm W J van Marwijk, Aartjan T F Beekman, Leona Hakkaart-van Roijen, Frans F Rutten, Jürgen Unützer, Christina M van der Feltz-Cornelis
Affiliations
Randomized Controlled Trial

Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

Marjoliek A IJff et al. BMC Health Serv Res. .

Abstract

Background: Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries.

Methods/design: This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months) are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36.

Discussion: In this study, an American model to enhance care for patients with a depressive disorder, the collaborative care model, will be evaluated for effectiveness in the primary care setting. If effective across the Atlantic and across different health care systems, it is also likely to be an effective strategy to implement in the treatment of major depressive disorder in the Netherlands.

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Figures

Figure 1
Figure 1
Flowchart of participants. GP: general practitioner, PHQ9: Patient Health Questionnaire depression sub-scale, MINI interview: Mini-International Neuropsychiatric Interview
See this image and copyright information in PMC

References

    1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet. 1997;349:1498–1504. doi: 10.1016/S0140-6736(96)07492-2. - DOI - PubMed
    1. Bijl RV, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS) Soc Psychiatry Psychiatr Epidemiol. 1998;33:587–595. doi: 10.1007/s001270050098. - DOI - PubMed
    1. De Graaf R, Bijl RV, Spijker J, Beekman ATF, Vollebergh WA. Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders – findings from the Netherlands Mental Health Survey and Incidence Study. Soc Psychiatry Psychiatr Epidemiol. 2003;38:1–11. doi: 10.1007/s00127-003-0597-4. - DOI - PubMed
    1. Ormel J, Bartel M, Nolen WA. [Undertreatment of depression; causes and recommendations. In Dutch] Ned Tijdschr Geneeskd. 2003;147:1005–1009. - PubMed
    1. Nutting PA, Rost K, Smith J, Werner JJ, Elliot C. Competing demands from physical problems: effect on initiating and completing depression care over 6 months. Arch Fam Med. 2000;9:1059–1064. doi: 10.1001/archfami.9.10.1059. - DOI - PubMed

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