چکیده (انگلیسی):

Background:Internationally, guidelines for depression recommend a stepped care approach, implying that
antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild
depression. In the Netherlands, antidepressant prescribing rates in general practice as a first treatment step are
considered to be high. The aim of this study was to evaluate the implementation of guideline recommendations
on antidepressant prescribing.
Methods:A quasi-experimental study with a non-equivalent naturalistic control group and three years follow-up
was performed in the general practice setting in the Netherlands. General Practitioners (GPs) participated in a
national Quality Improvement Collaborative (QIC), focusing on the implementation of a guideline based model for
a stepped care approach to depression. The model consisted of self-help and psychological treatment options for
patients with milder symptoms as an alternative to antidepressants in general practice. Changes in antidepressant
prescription rates of GPs were documented for a three-year period and compared to those in a control group of
GPs, selected from an ongoing national registration network.
Results:A decrease of 23.3% (49.4%-26.1%) in antidepressant prescription rates for newly diagnosed patients with
depressive symptoms was found within the intervention group, whereas no difference occurred in the reference group
(50.3%-52.6%). The decrease over time was significant, compared to the usual care group (OR 0.44, 95% CI: 0.21-0.92).
Conclusions:An implementation program using stepped care principles for the allocation of depression interventions
resulted in reduced antidepressant prescription rates in general practice. GPs can change prescribing behaviour within
the context of a QIC.