The clinical effectiveness of an algorithm-guided treatment program for depression in specialized mental healthcare: A comparison with efficacy trials

JOURNAL OF AFFECTIVE DISORDERS

卷:275

Article

Kan, Kaying¹  Feenstra, Talitha L.^2,3  de Vries, Sybolt O.⁴  Visser, Ellen⁵  Schoevers, Robert A.⁶  Jorg, Frederike^1,7 

[1] Univ Groningen, Univ Med Ctr Groningen, Univ Ctr Psychiat, Rob Giel Res Ctr,Interdisciplinary Ctr Psychopath, Hosp Zip Code CC72,POB 30001, NL-9700 RB Groningen, Netherlands

[2] Univ Groningen, Groningen Res Inst Pharm, Dept Sci & Engn, Groningen, Netherlands

[3] Natl Inst Publ Hlth & Environm RIVM, POB 1, NL-3720 BA Bilthoven, Netherlands

[4] Van Andel Dept Psychiat Elderly, GGZ Friesland, Borniastr 34b, NL-8934 CE Leeuwarden, Netherlands

[5] Univ Groningen, Univ Med Ctr Groningen, Univ Ctr Psychiat, Rob Giel Res Ctr, Hosp Zip Code CC72,POB 30001, NL-9700 RB Groningen, Netherlands

[6] Univ Groningen, Univ Med Ctr Groningen, Univ Ctr Psychiat, Interdisciplinary Ctr Psychopathol & Emot Regulat, POB 30001, NL-9700 RB Groningen, Netherlands

[7] GGZ Friesland, Res Dept, POB 932, NL-8901 BS Leeuwarden, Netherlands

关键词: Depressive disorder;    Algorithm;    Treatment outcome;    Guideline adherence;    Treatment adherence;    Routine outcome monitoring;   

DOI  :  10.1016/j.jad.2020.07.010

来源: Elsevier

【 摘 要 】

Background: Doubts exist on whether effects found in randomized controlled trials (RCTs) are directly generalizable to daily clinical practice. This study aimed (a) to investigate the effectiveness of treatment options within an algorithm-guided treatment (AGT) program for depression and compare their effectiveness with outcomes of efficacy trials and (b) to assess the relation between treatment continuity and outcomes. Methods: This naturalistic study linked treatment data from January 2012 to November 2014 from a Dutch mental healthcare provider, to routine outcome monitoring (ROM) data (N = 351). Effectiveness of the treatment options (pharmacotherapy, psychotherapy and their combination) was compared to the efficacy reported in the meta-analyses. We included treatment continuity as binary variable early terminators versus completers of the recommended number of treatment sessions. Results: Remission rates for psychotherapy (38% [95% CI: 32-45]), pharmacotherapy (31% [95% CI: 22-42]) and combination therapy (46% [95% CI: 19-75]) were respectively lower, comparable, and comparable to those reported in the meta-analyses. Similarly, response rates were respectively lower (24% [95% CI: 19-30]), lower (21% [95% CI: 13-31]), and comparable (46% [95% CI: 19-75]) to meta-analyses results. A similar share of early terminators and completers achieved remission and response. Limitations: A substantial proportion of patients had incomplete ROM data after data linkage. Limited set of patient characteristics to check for selection bias. Conclusions: Despite the more heterogeneous patient population in clinical practice, the effectiveness of an AGT program, emphasizing strict guideline adherence, approached that found in RCTs. A fixed number of treatment sessions may not suit all individual patients.

【 授权许可】

Free