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The British Journal of Psychiatry (2005) 187: 462-469
© 2005 The Royal College of Psychiatrists

Adherence to guidelines for treatment of depression in in-patients

FRANK SCHNEIDER, MD, PhD

Department of Psychiatry and Psychotherapy, University of Aachen

MARTIN HÄRTER, MD, PhD

Department of Psychiatry and Psychotherapy, University of Freiburg

SILKE BRAND, PhD

Department of Psychiatry and Psychotherapy, University of Aachen

PETRA SITTA

Department of Psychiatry and Psychotherapy, University of Freiburg

RALPH MENKE, MA

Department of Psychiatry and Psychotherapy, University of Düsseldorf

URSULA HAMMER-FILIPIAK, MD

State Hospital Weinsberg

RALF KUDLING, MD

Department of Psychiatry, Psychotherapy and Psychosomatics, Protestant Hospital, Gelsenkirchen

ANDREA HEINDL, PhD

State Hospital Bayreuth

KURT HEROLD

Department of Psychiatry and Psychotherapy, Hospital of Gummersbach

ULRICH FROMMBERGER, MD

Hospital of Psychiatry and Psychotherapy, Offenburg

OLIVIER ELMER, PhD

State Hospital Wiesloch

GÜNTER HETZEL, MD

Department of Psychiatry and Psychotherapy, University of Münster

GABRIELE WITT

Department of Psychiatry and Psychotherapy, Johanniter Hospital of Oberhausen

MANFRED WOLFERSDORF, MD

State Hospital Bayreuth

MATHIAS BERGER, MD

Department of Psychiatry and Psychotherapy, University of Freiberg

WOLFGANG GAEBEL, MD

Department of Psychiatry and Psychotherapy, University of Düsseldorf, Germany

Correspondence: Dr Frank Schneider, Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. E-mail: fschneider{at}ukaachen.de

Declaration of interest F.S., W.G. and M.B. were involved in the development of the DGPPN guidelines. Funding detailed in Acknowledgements.

Background Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment.

Aims To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines.

Method We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge.

Results The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy.

Conclusions The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.




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