[Benchmarking in patient care: depression in Parkinson's disease]

Depression is the most common mental disorder in patients suffering from Parkinson's disease (PD) with an average prevalence of about 40% to 50%. Depression in PD has a major impact on the patient's health-related quality of life and caregivers' distress. Although common depressive symptoms in PD are under-diagnosed and therefore often untreated in clinical practice. The aim of this study was to evaluate the current status of treatment in PD patients with depression in Germany and to develop approaches to improve awareness and therapy. The study was divided into three parts: 1. a pre-study to evaluate treatment patterns in a registry of PD patients with and without depressive symptoms, 2. a pilot trial to establish a valid and feasible questionnaire for patients with PD and depression, 3. main study: quality measurement by benchmarking in 14 centres followed by a final phase for developing an integrated algorithm for the treatment of PD patients with depression. In the main study only 27.6% of the patients received antidepressant therapy, and only 55% with moderate to severe depression were treated. Only seven patients received behavioural therapy. There were two groups: one with and the other without training and benchmark information. No significant difference could be detected between the two treatment arms. This study provided important data on the treatment of patients with PD and depression in Germany. There are a number of reasons for the observed lack of efficacy in this study. More studies are needed to develop an appropriate approach to performing benchmarking for the treatment of neurological disease.