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Table 1 GermanIMPACT stepped-care algorithm

From: Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial

Change of current PHQ score compared to baseline Recommended step
Improvement of less than 50% (including no improvement and worsening of symptoms) a) Medication-related changes (initiated by the GP) including initiation if patient is currently without medication, or
b) Training of problem-solving techniques provided by the care manager: two face-to-face sessions, four telephone sessions (approximately 45 minutes each); afterwards resumption of telephone sessions at two-week intervals
Improvement of 50% or more No treatment changes
PHQ-9 score <5 (remission) c) Discussion of a relapse prevention and emergency plan
  d) Reduction of telephone sessions to four-week intervals; in case of relapse, resumption of telephone sessions at two-week intervals