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Improving care for patients with depressive and anxiety disorders in primary and secondary care

English title Improving care for patients with depressive and anxiety disorders in primary and secondary care
Applicant Watzke Birgit
Number 167436
Funding scheme NRP 74 Smarter Health Care
Research institution Psychologisches Institut Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Psychology
Start/End 01.12.2017 - 30.09.2022
Approved amount 592'879.00
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All Disciplines (2)

Discipline
Psychology
Mental Disorders, Psychosomatic Diseases

Keywords (8)

Depressive disorders; Mental health care research; Secondary care; Psychotherapy; Anxiety disorders; Collaborative care; Complex intervention; Primary care

Lay Summary (German)

Lead
Ein relativ grosser Teil der Bevölkerung leidet unter Depressionen und Angststörungen. Aber nur bei einem kleinen Teil der Betroffenen werden diese Krankheiten korrekt und zeitnah diagnostiziert und behandelt. Hier setzt Forschungsprojekt an.
Lay summary

Untersuchungen zeigen, dass nur etwa eine von drei Personen mit einer psychischen Störung in der Schweiz fachgerecht behandelt wird. Die Folgen sind Gesundheitsbeeinträchtigungen, chronische Verläufe sowie hohe Kosten für das Gesundheits- und Sozialwesen. Gründe für die ungenügende Versorgung sind die mangelhafte Früherkennung und Behandlungsauswahl sowie Wartelisten bei Spezialisten. Nationale und internationale Initiativen wollen deshalb die Rolle der Grundversorger in diesem Bereich stärken. Ziel unseres Projekts ist es, die Erkennung, Diagnose und Behandlung von psychischen Krankheiten, insbesondere von Depressionen und Angsterkrankungen, in der Grundversorgung zu fördern. Hausärztinnen und Hausärzte im Grossraum Zürich werden zufällig in eine Interventions- und in eine Kontrollgruppe eingeteilt. Ärztinnen und Ärzte in der Interventionsgruppe werden darin geschult, Patientinnen und Patienten mit psychischen Störungen zu erkennen. Zudem erhalten sie Begleitung und Beratung durch spezialisierte Fachpersonen (Psychotherapeutinnen und Psychiater), die sich bei Bedarf auch direkt in die Behandlung einbringen. Aufgrund des Vergleichs der Interventions- mit der Kontrollgruppe werden die Wirksamkeit und die Kosten-Wirksamkeit der Intervention analysiert. Zudem wird der Umsetzungsprozess in der Praxis evaluiert. Das Projekt trägt dazu bei, die Erkennung, die Diagnose und die Behandlung von psychischen Störungen, insbesondere von Depressionen und Angststörungen, in der Grundversorgung zu optimieren. Im Sinne der Patienten setzt die untersuchte Intervention möglichst früh im Behandlungsprozess an, nämlich wenn es um die Frage geht, welche Erkrankung vorliegt und welche Behandlung ausgewählt werden soll. Die Intervention kann dabei auf weitere Arztpraxen und auch auf andere Erkrankungsgruppen ausgedehnt werden.

Direct link to Lay Summary Last update: 21.11.2017

Responsible applicant and co-applicants

Employees

Project partner

Collaboration

Group / person Country
Types of collaboration
Forschungsstelle für Psychotherapie, Institut für Psychosoziale Prävention, Universität Heidelberg Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Kompetenzzentrum Psychische Gesundheit, Universität Zürich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Mental Health & Addictions Research Group, Department of Health Sciences, University of York Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Institut für Hausarztmedizin, Universität Zürich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
- Exchange of personnel
Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Klinische Psychologie und Epidemiologie, Universität Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Wennberg International Collaborative Spring Policy Meeting Talk given at a conference Imrpoving Care for Patients with Depressive and Anxiety Disorders: A Consultation-Liaison Intervention in Primary Care (CoLiPri) 12.04.2018 Zürich, Switzerland Wüest Alexandra; Watzke Birgit; Wolf Markus;
1st Programme Conference of the NRP 74 Smarter Health Care Poster Improving Care for Patients with Depressive and Anxiety Disorders: Effectiveness & Cost-Effectiveness of a Consultation-Liaison Intervention in Primary Care 01.12.2017 Luzern, Switzerland Schwenkglenks Matthias; Rosemann Thomas; Wolf Markus; Wüest Alexandra; Watzke Birgit;


Communication with the public

Communication Title Media Place Year
New media (web, blogs, podcasts, news feeds etc.) Verbesserter Zugang zu evidenzbasierten Behandlungen für Menschen mit Depression und Angsterkrankung Newsletter of the Competence Center for Mental Health (CCMH) German-speaking Switzerland 2018

Associated projects

Number Title Start Funding scheme
200760 Intersession processes in psychotherapy using an ecological momentary assessment approach 01.03.2022 Project funding

Abstract

Background: Depressive and anxiety disorders are serious and disabling conditions that have a high prevalence in the population and are often seen in primary care. Growing awareness of the public health impact of mental health conditions, such as depression and anxiety disorders, has lend attention of health politics to the shortcomings in service provision for people with mental disorders. Despite recent advances in the treatment of depression and anxiety, a large percentage of patients is not adequately diagnosed and does not receive evidence-based treatments according to current medical guidelines. Objectives: The primary objective of the proposed 4-year project is to improve the identification and diagnosis, as well as clinical pathways and treatment of patients with depression and anxiety disorders in primary care by implementing and evaluating the effectiveness and the cost-effectiveness of a complex consultation-liaison intervention for general practitioners (GPs). The intervention comprises 1. an initial guideline-based training for GPs in screening, diagnostics and treatment of patients with a depressive or/and an anxiety disorder; 2. continuous quality management through quality circles for GPs; 3. implementation of a step-wise screening and diagnostic procedure; and 4. a novel enhanced consultation-liaison (CLI+) service provided by psychotherapists/ psychiatrists who will assist and support GPs in the guideline-concordant identification, individual treatment allocation, and treatment. Methods: The complex intervention will be evaluated using a prospective mixed-methods design. A two-group cluster-randomized trial will be conducted to evaluate the intervention’s feasibility and acceptability as well as its effectiveness and cost-effectiveness in primary care. To this end, GPs will be recruited and randomized to the intervention group where they will be supported in the management of patients with anxiety and/or depression by the intervention described above, or to a control group with care-as-usual (CAU) without additional support. Cluster-randomization will be based on the GP level. Recruitment of primary care practices (N=40) and patient enrolment (N=420) will take place in the catchment area of Zurich, Switzerland. Process and outcome data will be collected at the patient, GP and consulting psychotherapist/psychiatrist levels at baseline, and at 3-, 6-, and 12-month follow-up. Primary outcome will be clinical response over a course of 12 months follow-up assessed with standard clinical self-report measures (GAD-7, PHQ-9). Secondary analyses will assess thje patients' depressive and anxiety symptoms, health-related quality of life, and coping skills, as well as the intervention’s cost-effectiveness. Further analyses will focus on the implementation process, the feasibility and acceptability of the intervention, and its impact on quality-of-care indicators. Conclusions: It is expected that the intervention will lead to improved identification and diagnosis of patients with depressive and/or anxiety disorders and-based on this-to faster and better treatment indication, allocation and initiation in accordance with the recommendations of guidelines for unipolar depression and anxiety disorders. Ultimately, it is expected that increased mental health and social functioning of people affected by these highly prevalent, disabling and chronic conditions will reduce direct and indirect illness costs.
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