The multidisciplinary depression guideline for children and adolescents: an implementation study

Abstract

It is important that depressed patients receive adequate and safe care as described in clinical guidelines. The aim of this study was to evaluate the implementation of the Dutch depression guideline for children and adolescents, and to identify factors that were associated with the uptake of the guideline recommendations. The study took place in specialised child and adolescent mental healthcare. An implementation project was initiated to enhance the implementation of the guideline. An evaluation study was performed alongside the implementation project, using structured registration forms and interviews with healthcare professionals. Six multidisciplinary teams participated in the implementation study. The records of 655 patients were analysed. After 1 year, 72% of all eligible patients had been screened for depression and 38% were diagnosed with the use of a diagnostic instrument. The severity of the depression was assessed in 77% of the patients during the diagnostic process, and 41% of the patients received the recommended intervention based on the depression severity. Of the patients that received antidepressants, 25% received weekly checks for suicidal thoughts in the first 6 weeks. Monitoring of the patients' response was recorded in 32% of the patients. A wide range of factors were perceived to influence the uptake of guideline recommendations, e.g. the availability of capable professionals, available time, electronic tools and reminders, and the professionals' skills and attitudes. With the involvement of the teams, recommendations were provided for nationwide implementation of the guideline. In conclusion, a systematic implementation programme using stepped care principles for the allocation of depression interventions seems successful, but there remains room for further improvement.

Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose

“…While the recommendation to initiate antidepressant treatment in children with fluoxetine is highly specific and does not require any additional resources, the evidence base for the use of fluoxetine in young people is relatively limited, although stronger than that for other antidepressants [5], which may affect physicians’ confidence in the recommendation. Dedicated effort, for example implementation interventions [35], may be needed to improve adherence to guidelines. A variety of interventions have been found to increase guideline adherence, including provision of educational materials, audit and feedback, and reminders, but effects are modest [36].…”

Cost-Effectiveness Analysis of Genotype-Guided Treatment Allocation in Patients with Alcohol Use Disorders Using Naltrexone or Acamprosate, Using a Modeling Approach

“…It has to be acknowledged that current treatment guidelines for AUD do not mention a strict evaluation window for (pharmacological) interventions, unlike for example for antidepressant medication [42]. Moreover, in clinical practice a relapse is not necessarily an indication that the medication is ineffective, or a common reason for medication switch.…”

Dissemination and Implementation Research in Marriage and Family Therapy: An Introduction and Call to the Field

“…Hermens et al. () designed a study to examine the implementation of a set of guidelines for depression treatment as well as to identify factors that promoted the uptake of these guidelines. The authors utilized the CFIR model, specifically exploring facilitating factors and barriers to implementation (i.e., inner and outer setting CFIR domains).…”