Depression Healthcare program A multidisciplinary approach for patients with depressive complaints

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Depression Healthcare programA
multidisciplinary approach for patients with
depressive complaints

• Development and implementation
• Robert Vening MA GP/Head of Department IOZ
• Katinka Mijnheer MA, Programme coordinator care

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SGE

• Care provider of integrated
• primary health care
• Foundation established in 1982 from the Philips
  Medische Dienst (General practitioners service)
• 10 Health Centres in the various neighbourhoods
  of Eindhoven
• 80,000 patients (33 population Eindhoven)
• Employer of 260 employees e.g 48 general
  practitioners, 7 pharmacies, 29 physiotherapists,
  15 psychologists, 17 practice supporters GP
• Turnover /- 25 million euros
• Finance sources 90 treatments and 10 contract
  healthcare insurer

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Depression, problems in the practice

• Over-treatment of non-serious depression (80
  anti- depressants)
• Under-treatment of serious depression (waiting
  time, insufficient monitoring, drop-out)
• Under-diagnostics general practitioners practice
  (50 no diagnosis, diagnosis or treatment in 30
  too late)
• No patients involvement
• Insufficient use of standards

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Targets National Breakthrough project Depression

• To reduce the over-treatment with
  anti-depressives in non-serious depression
• To reduce the under-treatment of adults with
  serious depression

• With the use of the
• Stepped care method
• (opt for the least intensive aid of which
  sufficient effect is expected)
• the multidisciplinary depression guideline

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Results of National Breakthrough project
Depression

• Decline rates from 61 to 11 primary treated with
  antidepressants
• Increase of minimal interventions from 33 to
  88.
• Waiting times remained, but quicker diagnostics
  in the second line health care

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Indicators SGEDepression care programme

• Within 6 months 90 a BDI score lower than 10
• Two-thirds of the patients with non-serious
  depression receive the first 6 weeks exclusively
  minimal interventions
• In serious depression, start specific treatment
  within a month
• Cancellation within 1 month with a
  depression-specific treatment is lower than 15

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Original survey SGE conclusions

• 5 baseline characteristics not-deviating from
  literature
• Large variation prevalence between health centres
• High comorbidity and healthcare consumption 80
  more than 3 complaints
• Under registration 49 of antidepressant users
  has a corresponding code

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National Breakthrough Depression

• Min 6 max 12 weken
• 1e stap interventies
• 1 psycho-educatie
• 2 bibiliotherapie
• 3 cursus in de put,uit de put 4 begeleiding
• 5 kortdurende beh / PST
• 6 fysieke inspanning
• 9 overig
• Monitoring (1 BDI p/m)

bibliotherapie
Targetgroup 1 mild

• GP
• Coding P03/P76
• Assessment disease severity
• commencement of complaints
• Allocation targetgroup

• DSM-IV-diagnostiek
• Depressie spec. int.
• 7 Antidepressiva
• 8 GT,CGT,IPT
• 9 Overig
• Monitoring (1 BDI p/m)
• Drop-out reductie
• Begeleiding,
• zelfmanagement

Targetgroup 2 Serious or first step not effective

• We speak of a serious depression in the
  Depression Break through programme when
• the complaints consist for longer than 6 months
  or
• the depression does not or insufficiently react
  after 3 months on a first step intervention or
• if there is a situation of suicidal behaviour or
  psychotic characteristics or serious social
  disfunctioning.

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Modules from the Depression Care programme

• Module 1 Diagnostics, choice of intervention and
  start of monitors (BDI)
• Module 2 Minimal interventions (and BDI)
• Module 3 Referral 2nd line (serious depression)
• Module 4 The follow-up with serious depression
  (consults GP and BDI)

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Module 2 minimal interventions

• Colour in your life, an internet course (9x)
• Interapy, an intensive internet course (1 to 3
  months)
• Psycho-education, group meetings (3)
• Course down in the dumps, out of the dumps (12
  group meetings)
• Problem-Solving Treatment (4-6 conversations)
• Mindfulness (8 group meetings)
• Movement (6-16 weeks, 2-3 times per week)

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Attention for self management
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Implementation
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Terms and conditionsfor implementation

• Finances
• Intranet facilities, planning and online
  application
• Registration and electronic data exchange
  agreements between the various disciplines
• Patient friendly version (digital and on paper)
  of minimal interventions
• Original survey and evaluation

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Implementation

• Project group with broad composition
• Involvement care providers
• Realistic planning
• Training
• Communication, consultation and feedback

PDCA
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Thank you!!