Is there a gap between recommended and ‘real world’ practice in the management of depression in young people? A medical file audit of practice

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Hetrick, Sarah E ; Thompson, Andrew ; Yuen, Kally ; Finch, Sue ; Parker, Alexandra G (2012)

Background:\ud Literature has shown that dissemination of guidelines alone is insufficient to ensure that guideline recommendations are incorporated into every day clinical practice.\ud \ud Methods:\ud We aimed to investigate the gaps between guideline recommendations and clinical practice in the management of young people with depression by undertaking an audit of medical files in a catchment area public mental health service for 15 to 25 year olds in Melbourne, Australia.\ud \ud Results:\ud The results showed that the assessment and recording of depression severity to ensure appropriate treatment planning was not systematic nor consistent; that the majority of young people (74.5%) were prescribed an antidepressant before an adequate trial of psychotherapy was undertaken and that less than 50% were monitored for depression symptom improvement and antidepressant treatment emergent suicide related behaviours (35% and 30% respectively). Encouragingly 92% of first line prescriptions for those aged 18 years or under who were previously antidepressant-naïve was for fluoxetine as recommended.\ud \ud Conclusions:\ud This research has highlighted the need for targeted strategies to ensure effective implementation. These strategies might include practice system tools that allow for systematic monitoring of depression symptoms and adverse side effects, particularly suicide related behaviours. Additionally, youth specific psychotherapy that incorporates the most effective components for this age group, delivered in a youth friendly way would likely aid effective implementation of guideline recommendations for engagement in an adequate trial of psychotherapy before medication is initiated.
  • References (32)
    32 references, page 1 of 4

    1. Cheung AH, Zuckerbrot RA, Jensen PS, Ghalib K, Laraque D, Stein REK, the GLAD-PC Steering Group: Guidelines for adolescent depression in primary care (GLAD-PC): II treatment and ongoing management. Pediatrics 2007, 120:e1313-1326.

    2. American Academy of Child and Adolescent Psychiatry (AACAP): Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adoles Psychiatry 2007, 46(11):1503-1526.

    3. National Institute for Health and Clinical Excellence NICE: Depression in Children and Young People: Identification and management in primary, community and secondary care. Leicester, UK: The British Psychological Society; 2005.

    4. McDermott B, Baigent M, Chanen A, Fraser L, Graetz B, Hayman N, Newman L, Parikh N, Peirce B, Proimos J, et al: beyondblue Expert Working Committee (2010) Clinical practice guidelines: Depression in adolescents and young adults. Melbourne: beyondblue: the national depression initiative; 2011.

    5. Grol R: Successes and Failures in the Implementation of Evidence-Based Guidelines for Clinical Practice. Med Care 2001, 39(8(suppl2)):II-46-II-54.

    6. Grol R: Personal paper: beliefs and evidence in changing clinical practice. Br Med J 1997, 315(7105):418-421.

    7. Bodenheimer T: The American health care system: the movement for improved quality in health care. New Engl J Med 1999, 340(6):488-492.

    8. Laughren TP: Clinical review: relationship between antidepressant drugs and suicidality in adults. In Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research. Silvers Spring, MD: FDA; 2006. 2006-4272b1-01-fda.pdf.

    9. Dubicka B, Hadley S, Roberts C: Suicidal behaviour in youths with depression treated with new-generation antidepressants: meta-analysis. Br J Psychiatry 2006, 189:393-398.

    10. Hammad TA, Laugren T, Racoosin J: Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006, 63:332-339.

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