I. Bermejo

Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial

OBJECTIVEnDepressive disorders are of great medical and political significance. Although evidence-based guidelines have been published and educational initiatives have been launched to implement them, they are rarely actually used. The aim of the study was to implement clinical practice guidelines for outpatient care of depression using a practice-oriented and interdisciplinary approach.nnnDESIGNnControlled clinical trial with a naturalistic design (data collection within routine practice) designed as a prospective pre-post study.nnnSETTINGnOutpatient care.nnnPARTICIPANTSn29 general practitioners (intervention: 18; control: 11) and 15 psychiatrists (intervention: 11; control: 4). Overall, the treatment of 698 patients (two samples: pre: 361; post: 337) was documented.nnnINTERVENTIONns) Multifaceted intervention combining benchmarking, continuous medical education and interdisciplinary quality circles for the diagnosis and treatment of depressive disorders.nnnMAIN OUTCOME MEASURESnMixed-effects regression models for cluster-adjusted analysis of patients symptom reduction.nnnRESULTSnAlthough physicians in the intervention group improved their clinical effectiveness (proportion of patients with response/remission) to a greater extent than physicians in the control group (intervention: 48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysis failed to prove a statistically significant effect of the intervention on the treatment outcome.nnnCONCLUSIONSnAlthough no statistically significant improvements were found regarding the outcomes, the action programme provides important work, materials and results for an integrated treatment model for depression.

Entwicklung der S3- und Nationalen Versorgungs- Leitlinie Depression

ZusammenfassungDepressive Störungen zählen zu dennhäufigsten Beratungsanlässen und Erkrankungennin der Versorgung. Obwohl sie gutnbehandelbar sind, besteht – trotz der Fortschrittenin den vergangenen Jahren –nweiterhin Optimierungsbedarf hinsichtlichnder Diagnostik und Therapie. Die Implementierungnevidenz- und konsensusbasierternLeitlinien ist eine geeignete Maßnahme,num die Versorgung depressivernPatienten zu verbessern. Zurzeit wird fürnDeutschland eine evidenzbasierte LeitlinienDepression erarbeitet. Um ihre Akzeptanznund weite Verbreitung sicherzustellen,nwird diese Leitlinie im Konsens aller relevantennAkteure verabschiedet. ZukünftigenAufgabe ist es, eine an Leitlinien orientiertenDiagnostik und Behandlung regelhaftnin der Versorgung zu verankern.AbstractDepressive disorders rank among the mostnfrequent causes of consultation andndiseases in health care. Although they arentreatable, there is further need to optimizendiagnostics and therapy, despite sizablenprogress in recent years. The implementationnof evidence- and consensus-basednguidelines is an appropriate measure tonimprove care for depressive patients. Annevidence-based guideline for depression isncurrently being developed for Germany. Innorder to ensure its acceptance and a widendissemination, this guideline will be adoptednin consensus by all relevant health carenproviders in this field. According to this, it isna future challenge to anchor guidelinebasedndiagnostics and treatment in routinencare.Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guideline-based diagnostics and treatment in routine care.

Entwicklung der S3- undNationalen Versorgungs-Leitlinie Depression

ZusammenfassungDepressive Störungen zählen zu dennhäufigsten Beratungsanlässen und Erkrankungennin der Versorgung. Obwohl sie gutnbehandelbar sind, besteht – trotz der Fortschrittenin den vergangenen Jahren –nweiterhin Optimierungsbedarf hinsichtlichnder Diagnostik und Therapie. Die Implementierungnevidenz- und konsensusbasierternLeitlinien ist eine geeignete Maßnahme,num die Versorgung depressivernPatienten zu verbessern. Zurzeit wird fürnDeutschland eine evidenzbasierte LeitlinienDepression erarbeitet. Um ihre Akzeptanznund weite Verbreitung sicherzustellen,nwird diese Leitlinie im Konsens aller relevantennAkteure verabschiedet. ZukünftigenAufgabe ist es, eine an Leitlinien orientiertenDiagnostik und Behandlung regelhaftnin der Versorgung zu verankern.AbstractDepressive disorders rank among the mostnfrequent causes of consultation andndiseases in health care. Although they arentreatable, there is further need to optimizendiagnostics and therapy, despite sizablenprogress in recent years. The implementationnof evidence- and consensus-basednguidelines is an appropriate measure tonimprove care for depressive patients. Annevidence-based guideline for depression isncurrently being developed for Germany. Innorder to ensure its acceptance and a widendissemination, this guideline will be adoptednin consensus by all relevant health carenproviders in this field. According to this, it isna future challenge to anchor guidelinebasedndiagnostics and treatment in routinencare.Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guideline-based diagnostics and treatment in routine care.

Usefulness scale for patient information material (USE) - development and psychometric properties

BackgroundOne economical way to inform patients about their illness and medical procedures is to provide written health information material. So far, a generic and psychometrically sound scale to evaluate cognitive, emotional, and behavioral aspects of the subjectively experienced usefulness of patient information material from the patient’s perspective is lacking. The aim of our study was to develop and psychometrically test such a scale.MethodsThe Usefulness Scale for Patient Information Material (USE) was developed using a multistep approach. Ultimately, three items for each subscale (cognitive, emotional, and behavioral) were selected under consideration of face validity, discrimination, difficulty, and item content.The final version of the USE was subjected to reliability analysis. Structural validity was tested using confirmatory factor analysis, and convergent and divergent validity were tested using correlation analysis. The criterion validity of the USE was tested in an experimental design. To this aim, patients were randomly allocated to one of two groups. One group received a full version of an information brochure on depression or chronic low back pain depending on the respective primary diagnosis. Patients in the second group received a reduced version with a lower design quality, smaller font size and less information.Patients were recruited in six hospitals in Germany. After reading the brochure, they were asked to fill in a questionnaire.ResultsAnalyzable data were obtained from 120 questionnaires. The confirmatory factor analysis supported the structural validity of the scale. Reliability analysis of the total scale and its subscales showed Cronbach’s α values between .84 and .94. Convergent and divergent validity were supported. Criterion validity was confirmed in the experimental condition. Significant differences between the groups receiving full and reduced information were found for the total score (p<.001) and its three subscales (cognitive p<.001, emotional p=.001, and behavioral p<.001), supporting criterion validity.ConclusionsWe developed a generic scale to measure the subjective usefulness of written patient information material from a patient perspective. Our construct is defined in line with current theoretical models for the evaluation of written patient information material. The USE was shown to be a short, reliable and valid psychometric scale.

Effects of culture-sensitive adaptation of patient information material on usefulness in migrants: a multicentre, blinded randomised controlled trial

Objectives To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. Design Multicentre, double-blind randomised controlled trial. Setting 37 primary care practices. Participants 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. Interventions Intervention group: provision of culture-sensitive adapted material. Control group: provision of standard translated material. Main outcome measures Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. Secondary outcomes: patient-rated usefulness after 8u2005weeks and 6u2005months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. Results Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8u2005weeks; 6u2005months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). Conclusion Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. Trial registration number German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.

1421 – Outpatient depression treatment - comparative analysis of general practitioner's, psychiatrist's and psychotherapist's treatment strategies

Objective To analyze the status quo of outpatient treatment of depression from general practitioner s, psychiatrist s and psychotherapist s point of view. Method Pooled analysis of the outpatient treatment of depression of general practitioners (nxa0=xa0180), psychiatrists (nxa0=xa071), and psychotherapists (nxa0=xa0160). Survey performed to uncover the clinical process the clinical process, the perceived obstacles, and subjective responsibilities. Results The diagnosis of all three groups was based primarily on their clinical impression, rather than on formal diagnosis criteria. The cooperation with the medical-psychotherapeutic sector was assessed more favorably than cooperation with the psycho-social sector. Conclusions Needs for improvements particularly regarding diagnoses and an interdisciplinary cooperation.

1420 – Patient's language proficiency and inpatient depression treatment

Objective To analyze process and outcome quality of inpatient depression treatment depending on German language proficiency. Method Documentation of patients in 24 psychiatric hospitals in Baden-Wurttemberg (South Germany). The following three groups were matched according to age, gender, and education: native German speakers, non-native speakers with good German proficiency, and non-native speakers with limited German proficiency (67 in each group). Results Germans received more group psychotherapy than the other two groups (pxa0=xa0.003). No differences were found regarding pharmacotherapy. Non-native speakers with limited German proficiency were discharged an average of 19 days earlier than German speakers and 7 days earlier than non-native speakers with good German proficiency (pxa0=xa0.02). Compared to Germans, twice as many non-native patients with good German proficiency and nearly four times as many patients with limited German proficiency were discharged with depressive symptoms (pxa0=xa0.006). Conclusion Results confirm the significance of linguistic factors for the effectiveness of treatment of depressive patients and show a direct impact of linguistic factors on length of hospitalization.

1422 – Culture sensitive analysis of psychosomatic complaints in migrants in germany

Background To ensure an adequate health care of migrants, differentiated information on the association of cultural background and migration related factors and psychosomatic complaints are necessary. Method Cross-sectional questionnaire based survey regarding psychosomatic complaints of migrants from Turkey (nxa0=xa077), Italy (nxa0=xa095), and Spain (nxa0=xa067) and ethnic German resettled from the states of the former Soviet Union (nxa0=xa0196). Questionnaires distributed by non-health specific counselling agencies of welfare associations. Results The cultural background was a relevant factor for psychosomatic complaints, showing Turkish and ethnic German resettled migrants a higher likeliness, also compared to a sample of age corresponding Germans. Whereas Spanish and Italian migrants showed a lower risk for psychosomatic complaints. Also gender, feeling unwell in Germany and fatalism showed a significant association with psychosomatic complaints. Conclusion Migrants in Germany do not have per se a higher risk for psychosomatic complaints. A distinct differentiation by cultural background is necessary.

1390 – Barriers in the attendance of health care interventions by immigrants

Aim Analysis of barriers regarding the attendance of the health care system under consideration of cultural- and migrationrelated factors. Method Cross-sectional survey with immigrants from Turkey (nxa0=xa077), Spain (nxa0=xa067), Italy (nxa0=xa095) and German resettlers from the former Soviet Union (nxa0=xa0196), recruited on migration and addiction services of the German Caritasverband, the Arbeiterwohlfahrt and migrant organizations. Results Spanish and Italian immigrants mainly search for help in their families and social environment. Immigrants from the former Soviet Union use home remedies and experience more linguistic difficulties as barriers for the use of health services, just like Turkish immigrants. Turkish immigrants reported feeling misunderstood regarding their cultural peculiarities by the expert staff as another main barrier. Other major influence factors were German language proficiency and the subjective wellbeing in Germany. Conclusion The consideration of cultural-related as well as linguistic factors in health care services is an essential contribution for improving health care of immigrants.

P-585 - Depression and anxiety in elderly immigrants in Germany - a transcultural analysis

Background The association between migration and mental health remains unclear. To ensure an adequate health care of migrants, differentiated information on the association of migration and cultural background and mental disorders is necessary. Method Cross-sectional study on depression and anxiety of migrants from Turkey, Italy, Spain, and ethnic German resettled from the states of the former Soviet Union (nxa0=xa0435). Questionnaires were distributed by non-health specific counselling agencies of welfare associations and migrants’ self-organisations. Results High rates of anxiety (anxiety: 43.2%; generalised anxiety disorder: 23.0%) as well as depression (minor depression: 20.4%; major depression: 15.8%) were found. The Turkish migrants have the highest degrees of symptoms, whereas the Spanish migrants have the lowest one. Logistic regression analyses show that retired migrants with lower school qualification and feeling unwell in Germany have a higher probability of suffering from anxiety or depressive disorders. Additionally, Turkish migrants show a higher likeliness for depression, than the other migrant groups. Conclusion Our results suggest that migrants in Germany have a higher risk of current anxiety and depression than natives. The cultural background is an independent predictor for depression but not of anxiety.