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Stepped care offers the possibility of improvements on the micro-, meso- and macrolevel

November 16, 2018

Today’s topics in mental health care concern finding solutions for providing good patient care with a perceived scarcity of resources in the face of growing financial and administrative pressures and increasing caseloads. Stepped care offers the possibility of improvements on the micro-, meso- and macrolevel of care simultaneously.

In her PhD thesis entitled ‘The case for stepped care – Exploring the applicability and cost-utility of stepped-care strategies in the management of depression’, Jolanda Meeuwissen of the Trimbos Institute presents an approach to support care professionals in improved clinical decision making with stepped-care heuristics that reduce uncertainty around the prognosis and progression of depression, while avoiding both over-treatment and under-treatment in individual treatment strategies. This thesis also addresses quality improvement in depression care through stepped-care service delivery with care improvement strategies from a chronic care management approach. With the aim of advancing depression care for the direct benefit of patients, this thesis explores the applicability and cost-utility of stepped-care strategies.

The nature of depressive disorder, with substantial impact on quality of life for patients and their relatives, the high prevalence, substantial disease burden, and high accompanying costs, are making depressive disorder an obvious case example for stepped care in this thesis, especially considering the availability of clinical practice guidelines.

Healthcare policy can improve depression care by shaping the conditions to perform stepped-care strategies, as described in this PhD thesis. Care professionals can improve patient outcomes by applying stepped-care tools for clinical decision making, when uncertainty about the individual prognosis prevails. Stepped care enables stratifying care to the patient’s profile and a person-centred approach in daily practice of depression care. It currently holds that every patient with a depression is the case for stepped care.

About the Thesis

Dr. Jolanda Meeuwissen, PhD, has successfully defended her PhD thesis on November 7th, 2018, publicly,  at the VU University, Amsterdam. The thesis is online available.

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