Abstract

In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its implementation in the primary care setting in the Netherlands. Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, information sheets from professional associations. Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN) in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients. Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.

Highlights

  • Need for integrated care for depressionIn spite of the availability of evidence-based pharmacological and psychological treatments for depressive disorder, and specific guidelines for their application, patients with major depressive disorder (MDD) often receive less-than-optimal treatment in the Netherlands [1]

  • Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN) in the general practices and coverage of the treatment costs

  • Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients

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Summary

Introduction

In spite of the availability of evidence-based pharmacological and psychological treatments for depressive disorder, and specific guidelines for their application, patients with major depressive disorder (MDD) often receive less-than-optimal treatment in the Netherlands [1]. Possible reasons for this paradox are a lack of acknowledgement of the symptoms by patients and health care providers, delayed treatment, poor collaboration between general practitioners (GPs) and specialist mental health services, difficult access to these specialist services, poor treatment compliance, insufficient adherence to guidelines for treatment with antidepressants and psychotherapy, lack of psycho-education, little effect monitoring, not enough attention to relapse prevention and undervaluation of patients’ preferences [1, 2]. In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands

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