Hauke Felix Wiegand1, Christoph Sievers2, Matthias Schillinger3, Frank Godemann4. 1. Department of Psychiatry, Psychotherapy and Psychosomatics, St. Joseph-Krankenhaus Berlin Weißensee, Gartenstr. 1-3, 13088 Berlin, Germany. Electronic address: hauke.wiegand@gmx.net. 2. BARMER GEK Hauptverwaltung Strategische Analysen/Risikomanagement, Lichtscheider Str. 89, 42285 Wuppertal, Germany. Electronic address: christoph.sievers@barmer-gek.de. 3. St. Joseph-Krankenhaus Berlin Weißensee Gartenstr. 1-3, 13088 Berlin, Germany. Electronic address: m.schillinger@alexius.de. 4. Department of Psychiatry and Behavioural Medicine, St. Joseph-Krankenhaus Berlin Weißensee Gartenstr. 1-3, 13088 Berlin, Germany. Electronic address: f.godemann@alexius.de.
Abstract
BACKGROUND: Guideline oriented treatment strategies of Major depressive disorder (MDD) improve treatment outcomes and reduce risks of chronicity and recurrence. AIMS: Description of routine treatment reality and analysis of guideline fidelity in first episode MDD in Germany. Indicators: patients with severe or psychotic depression or severe psychiatric comorbidities' treatment by specialists, adequate antidepressant pharmacotherapy, permanent treatment with more than one antidepressant, long-term benzodiazepine treatment and provision of psychotherapy. METHOD: Descriptive analysis of routine data of the German statutory health insurance fund Barmer GEK in the index year 2011 that covers a population of 7,501,110. RESULTS: 236,843 patients were diagnosed a depressive episode. 53.0% of the patients with severe depression, 34.4% with psychotic depression and 50.9% with severe psychiatric comorbidities were treated by specialists; of the patients treated by a general practitioner 48.1% with severe and 47.3% with psychotic depression received an antidepressant; 9.7% of all patients with MDD got two antidepressants simultaneously; 8.3% received longterm benzodiazepine prescriptions; 26.1% got psychotherapy. LIMITATIONS: the analyses depends on the indicators definitions that cannot cope with the variety of individual treatment path; comparison with guidelines was complicated by a large fraction of patients with recurrent MDD that was wrongly diagnosed with first episode depression; due to the data structure, not all guideline recommendations could be examined CONCLUSIONS: Routine practice was oriented upon the guidelines recommendations. However some aspects could be identified that bear potential for improvements.
BACKGROUND: Guideline oriented treatment strategies of Major depressive disorder (MDD) improve treatment outcomes and reduce risks of chronicity and recurrence. AIMS: Description of routine treatment reality and analysis of guideline fidelity in first episode MDD in Germany. Indicators: patients with severe or psychotic depression or severe psychiatric comorbidities' treatment by specialists, adequate antidepressant pharmacotherapy, permanent treatment with more than one antidepressant, long-term benzodiazepine treatment and provision of psychotherapy. METHOD: Descriptive analysis of routine data of the German statutory health insurance fund Barmer GEK in the index year 2011 that covers a population of 7,501,110. RESULTS: 236,843 patients were diagnosed a depressive episode. 53.0% of the patients with severe depression, 34.4% with psychotic depression and 50.9% with severe psychiatric comorbidities were treated by specialists; of the patients treated by a general practitioner 48.1% with severe and 47.3% with psychotic depression received an antidepressant; 9.7% of all patients with MDD got two antidepressants simultaneously; 8.3% received longterm benzodiazepine prescriptions; 26.1% got psychotherapy. LIMITATIONS: the analyses depends on the indicators definitions that cannot cope with the variety of individual treatment path; comparison with guidelines was complicated by a large fraction of patients with recurrent MDD that was wrongly diagnosed with first episode depression; due to the data structure, not all guideline recommendations could be examined CONCLUSIONS: Routine practice was oriented upon the guidelines recommendations. However some aspects could be identified that bear potential for improvements.
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