Background:
There is little evidence whether or not guideline-concordant care in general practice will improve clinical outcomes in anxiety and depression patients. This study aims to determine possible associations between guideline-concordant care and clinical outcome in general practice patients with depression and anxiety, identification of patient and treatment characteristics associated with clinical improvement.
Methods:
This study was part of the Netherlands Study of Depression and Anxiety (NESDA).Adult patients, recruited in general practice (67 GPs) were interviewed to assess DSM-IV diagnoses during baseline assessment of NESDA, and completed questionnaires measuring symptom severity, received care, sociodemographic variables and social support at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care received. Guideline adherence was derived from medical record information from GPs.
Results:
721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline-concordant care (N=281) suffered from more severe symptoms than patients who received non-guideline concordant care (N=440), both groups improved equally on their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with low symptoms at follow-up. Specific kind of treatment made no difference.
Conclusion:
The added value of guideline-concordant care could not be demonstrated in this study. Symptom severity, employment status, social support and comorbidity of anxiety and depression play a role in poor clinical outcome(246 words)