Clinical behavior toward outpatients with major depressive disorder based on guideline education for psychiatrists

The Effectiveness of Guideline for Dissemination and Education in Psychiatric Treatment (EGUIDE) project has improved psychiatrists' adherence to guidelines and their treatment behavior for hospitalized patients. However, treatment behavior toward outpatients has not been sufficiently investigated. This study aimed to examine the effects of the EGUIDE program on the clinical behavior of psychiatrists toward outpatients with major depressive disorder (MDD).

A comparative study was conducted among outpatients at seven facilities. The study included 255 patients who had received a primary diagnosis of MDD at the initial visit and had been followed for 6 months or more since the initial visit. The prescription types were investigated at the 6-month follow-up. The primary outcomes were the rate of severity diagnosis, the rate of antidepressant monotherapy without other psychotropics, the rate of antidepressant monotherapy, the rate of no anxiolytic/hypnotic prescriptions, and the rate of intermittent psychotropic medication prescription. The secondary outcomes were the imipramine equivalent dose of antidepressants and the diazepam equivalent dose of anxiolytics/hypnotics.

Patients treated by psychiatrists who were participating in the EGUIDE project had a significantly higher rate of severity diagnosis than patients treated by psychiatrists who were not participating in the EGUIDE project. However, there were no significant differences in the other primary outcomes. In terms of the secondary outcomes, the diazepam equivalent dose was significantly lower in patients treated by psychiatrists who were participating in the EGUIDE project.

Participation in the EGUIDE project was associated with improved severity diagnosis rates among outpatients with MDD, but its effect on prescribing behaviors was limited.