The clinical effectiveness of an algorithm-guided treatment program for depression in specialized mental healthcare: A comparison with efficacy trialsKan, K., Feenstra, T. L., de Vries, S. O., Visser, E., Schoevers, R. A. & Jorg, F., 9-Jul-2020, In : Journal of Affective Disorders. 275, p. 216-223 8 p.
Research output: Contribution to journal › Article › Academic › peer-review
- PharmacoTherapy, Epidemiology and Economics
- Value, Affordability and Sustainability (VALUE)
- Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)
- Clinical Cognitive Neuropsychiatry Research Program (CCNP)
- Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE)
- Perceptual and Cognitive Neuroscience (PCN)
Background: Doubts exist on whether effects found in randomized controlled trials (RCTs) are directly generalizable to daily clinical practice. This study aimed (a) to investigate the effectiveness of treatment options within an algorithm-guided treatment (AGT) program for depression and compare their effectiveness with outcomes of efficacy trials and (b) to assess the relation between treatment continuity and outcomes.
Methods: This naturalistic study linked treatment data from January 2012 to November 2014 from a Dutch mental healthcare provider, to routine outcome monitoring (ROM) data (N = 351). Effectiveness of the treatment options (pharmacotherapy, psychotherapy and their combination) was compared to the efficacy reported in the meta-analyses. We included treatment continuity as binary variable "early terminators versus completers of the recommended number of treatment sessions".
Results: Remission rates for psychotherapy (38% [95% CI: 32-45]), pharmacotherapy (31% [95% CI: 22-42]) and combination therapy (46% [95% CI: 19-75]) were respectively lower, comparable, and comparable to those reported in the meta-analyses. Similarly, response rates were respectively lower (24% [95% CI: 19-30]), lower (21% [95% CI: 13-31]), and comparable (46% [95% CI: 19-75]) to meta-analyses results. A similar share of early terminators and completers achieved remission and response.
Limitations: A substantial proportion of patients had incomplete ROM data after data linkage. Limited set of patient characteristics to check for selection bias.
Conclusions: Despite the more heterogeneous patient population in clinical practice, the effectiveness of an AGT program, emphasizing strict guideline adherence, approached that found in RCTs. A fixed number of treatment sessions may not suit all individual patients.
|Number of pages||8|
|Journal||Journal of Affective Disorders|
|Early online date||9-Jul-2020|
|Publication status||E-pub ahead of print - 9-Jul-2020|
- Depressive disorder, Algorithm, Treatment outcome, Guideline adherence, Treatment adherence, Routine outcome monitoring, COGNITIVE-BEHAVIORAL THERAPY, STAR-ASTERISK-D, MAJOR DEPRESSION, PHARMACOLOGICAL-TREATMENT, SYMPTOMATOLOGY IDS, PSYCHOTHERAPY, ADHERENCE, PHARMACOTHERAPY, METAANALYSIS, GUIDELINES