Abstract
BackgroundThere is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general practice patients with depression and anxiety, and identify patient and treatment characteristics associated with clinical improvement.MethodsThis study forms 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 also completed questionnaires measuring symptom severity, received care, socio-demographic variables and social support both at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care received. Information on guideline adherence was obtained from GP medical records.Results721 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 showed equal improvement in 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 mild symptoms at follow-up. The particular type of treatment followed made no difference to clinical outcomes.ConclusionThe 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 all play a role in poor clinical outcomes.
Highlights
There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression
Patients who received guideline concordant care were more likely to suffer from comorbidity of both anxiety and depressive disorders, than they were to suffer from an anxiety disorder only, compared with patients who received non-guideline concordant care
Guideline concordant care is provided by general practitioners for more severe cases of depression and anxiety
Summary
There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. In the Netherlands, the Dutch College of General Practitioners (DCGP) issued evidence-based general practice guidelines for depression and anxiety [15,16], which are widely accepted and play a prominent role in continuing professional development programmes for medical practitioners[17]. These guidelines follow the international accepted state of the art and are comparable with British [14] and American [18] guidelines
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