Study Reveals Opportunities to Improve Treatment of Depression - Results give a good basis for re-design of patient care pathways

” We at HUS Psychiatry are committed to improving the real-world effectiveness of the treatments provided through this VBHC approach. This requires understanding of outcomes in a comprehensive way and how real-world clinical practices compare to the clinical guidelines.” says Jesper Ekelund, Director of HUS Psychiatry.

The study found that a majority of patients had received fewer than two appropriate medication treatments (as recommended by the treatment guidelines) before being assessed by specialised psychiatric services. That may relate to lack of resources in primary care, but there may also be improvement potential in the current care practices.

“To ensure patients receive the right treatment at the right time, we need closer collaboration and clearer pathways between primary care and specialised services,” says Jonne Juntura, Resident at HUS Psychiatry.

Following the assessment by specialised psychiatric care, the proportion of patients receiving adequate pharmacological treatment increased and the majority were treated with monotherapy. However, more advanced treatments, such as combination and augmentation therapies were less common than expected indicating a need for deeper analysis of care processes.

“Even though these analyses are leveraging data from before the pandemic and the national Sote reform, we are aware that similar patterns persist today. This warrants us to think critically about how we organize services for patients receiving care at HUS, particularly in the immediate period following assessment, to achieve the best possible outcomes,” Grigori Joffe, Principal Investigator at HUS Psychiatry.

Improving Care Pathways Through Service Design

This study, conducted as part of a value-based healthcare collaboration between HUS, the University of Helsinki, and Janssen-Cilag International NV, a Johnson & Johnson company, builds on earlier findings indicating that depression-related costs to society are higher than previously estimated, and is also a part of the “Transparency and Accountability in Social and Health Care” project. Treatment patterns in the same patient cohort were monitored over a 24-month period, specifically before and after assessment by specialised psychiatric care. The study utilized Finnish patient data from 19 national and municipal registries in the Helsinki-Uusimaa region between 2014 and 2020.

The findings from both studies are already being utilized in the service design process, where the current practices are analyzed in more detail and developed in collaboration with professionals from specialised and primary care, and with patients.

“Service design, as a systematic approach to planning and optimizing service systems, holds transformative potential for health and social care. It focuses on improving outcomes and experiences for patients and providers by aligning people, infrastructure, communication, and processes. In partnership with HUS and Johnson & Johnson, we are segmenting patients based on their needs and developing service pathways for each segment to enhance the quality of care for patients with depression,” says Paulus Torkki, Associate Professor at the University of Helsinki.

The study is a part of the Transparency and Accountability in Social and Health Care project. The results of the study, titled "Changes in Depression Medication Following the Initial Assessment by Specialized Psychiatry Services," were presented at the European Congress of Psychiatry (EPA) 2025, held April 5-8, 2025, in Madrid. 

The aim of the “Transparency and Accountability in Social and Health Care” research and development project by HUS and several partners is to create instructions and tools that can easily be used to combine, analyze, and visualize national and regional register data in health and social services as a basis for development and research work. First, the actual use of mental health and substance misuse services, the treatment outcomes, and costs were examined. The aim is to create data models and processes enabling similar analyses of other patient groups. The project promotes the effectiveness-based development of the service system. As a basis for the project, a unique database has been created that comprises combined data from health care, social services, THL, Kela, and Statistics Finland registers over a period of seven years for approximately 630,000 patients in Uusimaa.