Schneider Frank, Kratz Sandra, Bermejo Isaac, Menke Ralph, Mulert Christoph, Hegerl Ulrich, Berger Mathias, Gaebel Wolfgang, Härter Martin
Department of Psychiatry and Psychotherapy, University of Aachen, Germany.
Ger Med Sci. 2004 Feb 26;2:Doc01.
The present status of outpatient treatment of depression in Germany was evaluated with respect to the adherence of general practitioners (GPs) and specialists of psychiatry to clinical practice guidelines.
In total, 488 depressed patients' psychopathology, diagnostic assessment, therapeutic measures and referral frequency were documented at inclusion into study by 43 general practitioners and 23 specialists of psychiatry in three regions of Germany. The investigation of change in depressive symptoms after six to eight weeks by means of self-assessment could be evaluated for 165 patients.
The results of diagnostic assessment demonstrated that diagnoses of depression were not always based on the diagnostic criteria for depression (ICD-10): 33% of GPs' and 17% of specialists' patients were included as depressed patients into the study despite not fulfilling the ICD-10 criteria in the standardized documentation. Therapeutic undertreatment was more often found in the group of GPs. Referrals were found not to be oriented towards guidelines. After six to eight weeks, one half of patients reported a reduction in depressed symptoms, the other half of patients reported a stagnation or even a progression.
The study has shown that physicians in outpatient settings still fail to orient themselves towards guideline recommendations. This reflects the need for physicians to receive guideline training, with the aim of improving the quality of care for depression. A quality management intervention program consisting of guideline training and an interdisciplinary quality circle to improve depression treatment and networking was supported by the authors and is currently being evaluated.
针对德国抑郁症门诊治疗现状，评估了全科医生（GP）和精神科专科医生对临床实践指南的遵循情况。
德国三个地区的43名全科医生和23名精神科专科医生在纳入研究时记录了总共488名抑郁症患者的精神病理学、诊断评估、治疗措施和转诊频率。165名患者通过自我评估对六至八周后抑郁症状的变化进行了调查评估。
诊断评估结果表明，抑郁症诊断并非总是基于抑郁症诊断标准（ICD - 10）：在标准化记录中，尽管不符合ICD - 10标准，但仍有33%的全科医生的患者和17%的专科医生的患者被纳入抑郁症患者研究。全科医生组中治疗不足更为常见。发现转诊并非遵循指南。六至八周后，一半患者报告抑郁症状减轻，另一半患者报告症状停滞甚至加重。
该研究表明门诊医生仍未以指南建议为导向。这反映出医生需要接受指南培训，以提高抑郁症护理质量。作者支持一项由指南培训和跨学科质量改进圈组成的质量管理干预计划，以改善抑郁症治疗和联系网络，目前该计划正在评估中。
