Evaluation of an educational program on depressive disorders given to general practitioners on Gotland : Short and long-term effects

Sammanfattning: In the years 1983-1984, the Swedish Comittee for the Prevention and Treatment of Depression (PTD) offered an educational program to all general practitioners (GP:s) on the Swedish island of Gotland. 1982 was used as a baseline year. An evaluation of the short-term effects was made continuously until 1985. The long-term effects were followed 1985-1988. According to the immediate evaluation, 80% considered the practical applicability of the program to be high, and the GP:s achieved increasing competence and stringency in handling depressive states.The referrals to the local psychiatric unit decreased to 50% of those at baseline. The total in-patient days due to depressive disorders decreased as well as the average stay. The sick-leave consumption decreased by approximately 50%. In 1982, the prescription of antidepressants was low, 54% of that in the rest of Sweden. In 1985 the corresponding figure was 77%. The prescriptions of lithium remained stable while the prescriptions of sedatives and major tranquilizers decreased as compared to the rest of Sweden. The suicide  rate decreased relative to the trends on Gotland and in the rest of Sweden. During the long-term evaluation, the in-patient care for depressive disorders increased again and the suicidal rate returned almost to control values. The prescriptions of antidepressants stabilised. Thus, the effects were strictly time related to the educational program indicating real effects and not only coincidence with local trends on the island.In a cost-benefit analysis the costs for the educational programs, the changes in drug prescriptions and in in-patient care were evaluated as well as indirect costs concerning changes in morbidity and mortality. The results indicate that the PTD educational program on Gotland resulted in savings to the society in the order of about SEK 155 million (USD 26 million). It is concluded that educational programs of this kind should be repeated every second to third year.