Research Program Diagnosis and Treatment, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands; Department of General Practice and Institute for Research in Extramural Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Int J Integr Care. 2009 Jun 15;9:e81. doi: 10.5334/ijic.313.
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.
在美国开发的一项有前途的抑郁症协作护理模式“抑郁倡议”被改编为在荷兰实施。
描述一种用于治疗重度抑郁症（MDD）的协作护理模式，以及影响其在荷兰初级保健环境中实施的因素。
在“抑郁倡议”的 CC:DIP 试验的准备阶段收集的数据、文献、政策文件、专业协会的信息表。
促进协作护理模式实施的因素是顾问精神病医生和培训师对护理经理的持续监督、支持性的基于网络的跟踪系统和新的报销系统，该系统允许在一般实践中引入心理健康护理护士（MHC-PN）并涵盖治疗费用。阻碍因素可能是单一初级保健实践的比例相对较高、位于同一建筑物中的专业人员比例较小、对协作护理所需的协作概念不熟悉、要求每个医疗保健提供者与保险公司定期协商的报销系统以及全科医生可能不愿意扩大对其抑郁患者的责任。
在荷兰实施协作护理模式需要在微观层面进行广泛的培训和监督，在中观和宏观层面促进报销，并在初级保健环境中进行结构性努力来改变对慢性精神障碍的治疗文化。
