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document
Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care ; a randomised clinical trial . BACKGROUND Depressive disorder is currently one of the most burdensome disorders worldwide . Evidence-based treatments for depressive disorder are already available , but these are used insufficiently , and with less positive results than possible . Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm , and research in the UK has also shown good results with Problem Solving Treatment . These treatment strategies may also work very well in the Netherlands too , even though health care systems differ between countries . METHODS/DESIGN This study is a two-armed randomised clinical trial , with randomization on patient-level . The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework , including contracting and adherence-improving strategies , combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm . Forty general practices will be randomised to either the intervention group or the control group . Included will be patients who are diagnosed with moderate to severe depression , based on DSM-IV criteria , and stratified according to comorbid chronic physical illness . Patients in the intervention group will receive treatment based on the collaborative care approach , and patients in the control group will receive care as usual . Baseline measurements and follow up measures ( 3 , 6 , 9 and 12 months ) are assessed using questionnaires and an interview . The primary outcome measure is severity of depressive symptoms , according to the PHQ9 . Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR , and cost-effectiveness measured with the TiC-P , the EQ-5D and the SF-36 . DISCUSSION In this study , an American model to enhance care for patients with a depressive disorder , the collaborative care model , will be evaluated for effectiveness in the primary care setting . If effective across the Atlantic and across different health care systems , it is also likely to be an effective strategy to implement in the treatment of major depressive disorder in the Netherlands .
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Intervention_Control
collaborative care including PST
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Intervention_Pharmacological
antidepressant treatment algorithm
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Intervention_Control
collaborative care approach with Problem Solving Treatment
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Intervention_Pharmacological
antidepressant treatment algorithm
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Intervention_Control
Problem Solving Treatment
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Intervention_Control
questionnaires
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Intervention_Control
interview
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Intervention_Control
collaborative care model
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Outcome_Other
Cost-effectiveness
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Outcome_Physical
Problem Solving Treatment
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Outcome_Mental
treatment
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Outcome_Mental
severity of depressive symptoms
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Outcome_Physical
remission as measured with the PHQ9 and the IDS-SR ,
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Outcome_Other
cost-effectiveness
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Outcome_Other
the TiC-P
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Outcome_Other
the EQ-5D
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Outcome_Other
the SF-36
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Participant_Condition
major depressive disorder
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Participant_Sample-size
Forty