1. Algemene gegevens / General Information

Transcriptie

1 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: Algemene gegevens / General Information DEFINITIEF Projecttitel / Project title Outcomes research of mood and anxiety disorders in outpatient mental health care. Aanvrager / Applicant Drs. R van der Lem T: F: E: lemr@parnassia.nl Parnassia, Psycho-medisch Centrum Wetenschappelijk Onderzoek Monsterseweg RJ 'S-GRAVENHAGE Projectleden / Project members Dr. E. de Beurs (Co-Promotor) T: F: E: Leiden University Medical Center Psychiatrie Albinusdreef, PO Box RC Leiden Nederland Drs. C.J. Witte (Bestuurlijk verantwoordelijke) T: F: E: Rivierduinen Postbus AT LEIDEN Nederland Prof. dr. F.G. Zitman (Projectleider en penvoerder) T: F: E: Leiden University Medical Center Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 1

2 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF Psychiatry Albinusdreef, PO box RC Leiden Nederland Drs. R. van der Lem (Uitvoerder) T: F: E: Erasmus MC (huidig werkadres tot ) Psychiatrie Consultatieve Dienst Postbus DR ROTTERDAM Nederland Samenwerking / Collaboration Rivierduinen Postbus AT LEIDEN Leids Universitair Medisch Centrum Divisie 3 Psychiatrie Postbus RC LEIDEN 2. Projectgegevens / Project information Programma / Programme Opleiding Onderzoekers GGZ (OOG) Subsidieronde / Subsidy round uitgewerkte aanvraag GGZ (OOG), derde ronde Datum indienen (via ProjectNet) / Date of application :11 Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 2

3 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF Aandachtsgebieden / Focus Doelgroep: Inhoudelijk thema: Stemmingstoornissen; Angsstoornissen; Projecttype / Project type Onderzoeksproject Samenvatting / Summary For mood and anxiety disorders several evidence-based treatments are available. The evidence of their efficacy is largely based on randomized clinical trials (RCT's) with strict methodological constraints, such as stringently selected patient groups without co morbidity, and with time limited treatments. The effectiveness of these treatments when applied in real life clinical settings with patients and treatment conditions that do not fulfill the strict criteria of RCT's is largely unknown. However, there is a growing need in patients, clinicians and other decision makers to know the effectiveness of these evidence-based treatments when applied in regular mental health care. Outcomes research is a methodology that can provide that information. In this study the effectiveness of treatments for mood and anxiety disorders in real life will be investigated with a large, still growing database (Psychiatric Academic REgistration Leiden, PAREL), now containing data of over 2300 patients that will provide the information needed for outcomes research. Based on limited literature available, it is expected that treatment in regular mental health care is less effective than RCT's. Second aim of this study is to investigate patient-, treatment- and therapist-variables that can explain this discrepancy. The results of this outcomes research will be highly relevant for every day clinical practice and may help to improve the effectivity of treatments of mood and anxiety disorders in mental health care. 3. Inhoud / Content Probleemstelling / Problem definition In the past decades evidence based treatments have been developed for mood and anxiety disorders. The evidence of their therapeutic effectivity is largely based on randomized controlled trials (RCT's) with strict methodological constraints, such as stringently selected patient groups without co morbidity, and time limited treatments, i.e. on their efficacy. The effectivity when applied in real life clinical settings with patients with co morbidity and co medication and with treatments characterised by protocol deviations, i.e. their effectiveness is largely unknown. It is probable that the effectiveness of treatments is smaller than the efficacy as can concluded, albeit largely indirectly, from the available data (Weiden and Olfson, 1995)(Gilbody, House, & Sheldon, 2002a). The need for research relating to effectiveness (rather than efficacy) has prompted a number of responses. One has been to conduct randomized trials in real world settings, using more pragmatic designs than in RCT's (Hotopf, 2002). Such designs, just like RCT's, still require major efforts to carry them out in clinical practice. Although to a lesser extent, they deviate like RCT's from routine clinical practice. Besides, they are by definition methodologically less rigorous than RCT's. Another response involves the analysis of large databases of patient information collected in routine Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 3

4 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF settings, known as outcomes research. It was first advocated by Ellwood (Ellwood, 1988). As the observational data are routinely collected for all patients, the results can be applied more generally. Further, data are generated in routine health-care services, rather than in artificially constructed trials. Lastly, outcomes research might be able to deliver answers to some questions quickly, cheaply and with greater statistical power, and without the need to seek ethical approval and individual patient consent, an advantage over the time consuming and costly randomised trial. Outcomes research has also weaknesses: the data available in routine clinical practice meet in general not all methodological requirements and consequentially research becomes driven by the availability of data rather than by the need to answer specific questions. Another problem is confounding and selection bias resulting from the omission of randomized assignment as in RCT's. Patients differ in various ways other than the treatment they receive, making it difficult to attribute differences in outcome to only the treatment itself (Gilbody, House, & Sheldon, 2002)(Gilbody, House, & Sheldon, 2002a). However, the more is known about potentially confounding factors the more it will be possible to study their influence and eventually statistically correct for them. Outcomes research can provide a useful approximation of the effectiveness of treatments in the real world if a number of criteria is fulfilled. Rosenheck et al. (Rosenheck, Fontana, & Stolar, 1999c) outlined the ingredients of a successful clinical database capable of producing rigorous and informative research: outcomes databases should include large numbers of subjects, use standardized instruments that are appropriate for the clinical conditions being treated, measure outcomes in multiple relevant domains, include extensive data in addition to outcomes measures in order to support matching, collect data at standardized intervals after a sentinel event such as the first contact with secondary care, take aggressive steps to achieve the highest possible follow-up rates and collect the data prospectively. We would like to add that the database should also contain information on major possible confounding factors. Relevantie / Relevance Mental health care is evolving from opinion-based to evidence-based clinical practice: the results of randomized controlled trials (RCT's) are guiding routine clinical practice more and more. However, the results of RCT's (the efficacy of treatments) are not necessarily the same as the results of treatments in the real world (the effectiveness of treatments) as the tightly controlled experimental conditions of the former differ much from the often-variable routine clinical conditions of the latter. The generalisability of findings from RCT's for clinical practice is therefore limited. Although data on effectiveness would be very relevant, in (Dutch) mental health care a paucity of these data exists. In mental health care at least 50% of the outpatients is treated for mood and / or anxiety disorders. The last two decades showed an accumulation of RCT's on the effects of psychotropic drugs, especially antidepressants, and psychotherapy, especially behavioral therapy, in these disorders. The results have had a major impact on the treatment in routine clinical practice. However, it is largely unknown to what extent their effects in clinical practice are comparable to the effects attained in controlled trials and which factors explain possible differences. It is the aim of the study described in this proposal to fill this gap in our knowledge. Findings of this study will help to improve effectivity of treatment. In clinical practice a paucity of instruments and methods exist with which the effectiveness can be assessed in local organizations. The results of this study will demonstrate the feasibility of a software program and the employment of a new group of mental health workers, the psychiatric test nurses, to improve the effectiveness and quality of care. Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 4

5 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF This project is also relevant within the ZONMW Geestkracht program as it is directed at optimizing and evaluating care for patients with mood and anxiety disorders in mental health care. It also contributes to bridging the gap between research and clinical practice as it has as its topic the relation between efficacy (research outcomes) and effectiveness (clinical practice outcomes). Kennisoverdracht, implementatie, bestendiging / Knowledge transfer, implementation, consolidation By discussing our plans and results we hope to increase the awareness that outcomes research is a feasible way to evaluate the effectiveness of treatments and that it offers opportunities to start a feedback-loop to improve quality of care, and treatment effectiveness in clinical practice (our project can be considered as the first part of such a feedback-loop). We will do so in our own organization, Rivierduinen, on national and international conferences and in papers in Dutch and English. Building an infrastructure for outcomes research is a commendable goal by itself, as it has increased awareness for the need of treatment evaluation in our clinic. Important in this respect is also that we have already much know-how about the set-up and implementation of the infrastructure that is indispensable for outcomes research. This expertise will, of course, also be disseminated in the same ways as the results of our evaluation itself. As the research project will be carried out by drs. R. van der Lem who will be working at the same time in a non-university mental health clinic in which routine monitoring (as described in 'Plan van Aanpak') is applied, she will be in a unique position to get experience in the cross-talk required for the implementation of outcomes research and the interpretation of the results in useful advice for clinical practice. She will also spend part of her time on the dissemination of this knowledge. The dissemination of this knowledge will be in writing (articles published in national and international papers) and in person, i.e. by giving lectures and/or courses in other mental health institutions in the Netherlands. In this way we hope to contribute to improve interest in outcomes research in the Netherlands. Doelstelling / Objective The aim of this study is to investigate the effectiveness of treatment in routine clinical practice with respect to anxiety and mood disorders in secondary outpatient care. More specifically we will answer the following questions: 1. What is the effectiveness of outpatient treatment of mood and anxiety disorders and how does it compare to the results from Randomized Controlled Trials? 2. Which patient, therapist, and treatment factors are related to treatment gain in clinical practice? To answer these questions we will use the methodology known as outcomes research (Rosenheck, Fontana, & Stolar, 1999b). The database we use is the Psychiatric Academic REgistration Leiden (PAREL) database. PAREL fulfils most of the criteria formulated by Rosenheck et al (Rosenheck, Fontana, & Stolar, 1999a). It contains the assessments of over 2300 patients and is still growing. Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 5

6 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 Plan van aanpak / Strategy DEFINITIEF THE OUTCOMES DATABASE Since 2002 the mental health institution Rivierduinen and the department of psychiatry of Leiden University Medical Center (LUMC) collaborate in Routine Outcome Monitoring of treatment results in outpatients with mood, anxiety and somatoform disorders. Rivierduinen is the main mental health care provider in Leiden and vicinity, with a catchment area of over people. Since 2002 the number of centres of Rivierduinen participating in Routine Outcome Monitoring is growing steadily. In March 2005 GGZ Leiden, GGZ Rijnstreek in Alphen ad Rijn, GGZ Duin en Bollenstreek in Voorhout en GGZ Haagstreek in Leidschendam were involved. In 2005 two centers have been added: GGZ Middenholland in Gouda and GGZ-Haagstreek in Zoetermeer. Routine Outcome Monitoring is carried out by psychiatric test nurses. They investigate treatment progress every three to four months through assessments with questionnaires and rating scales. Immediately following the assessment session they write a short report, summarizing the main findings (for instance :the patient is not changed/improved/recovered according to the x-subscale of the BSI). Therapists discuss the findings with their colleagues in treatment progress meetings every three months and decide on the future course for the treatment. Furthermore, they provide feedback to the patients regarding their progress according to the findings of Routine Outcome Monitoring. Psychiatric test nurses are extensively trained in completing the structured diagnostic interview (MINI) and administration of the rating scales (MADRS, GAF, CGI) and are supervised by senior colleagues and one of the project members (dr. E.de Beurs). In addition, the psychiatric test nurses attend monthly training sessions and weekly intervision sessions in order to keep inter-rater reliability at a sufficiently high level. In their work psychiatric test nurses are aided by software (Questmanager) to administer the diagnostic interview, rate the severity of symptoms, and present questionnaires to patients by means of a touch screen. In August 2005 twelve psychiatric test nurses are involved in Routine Outcome Monitoring. Initial assessment takes place at the intake and comprises (1) diagnostic data through a standardised diagnostic interview (MINI) by a psychiatric test nurse, (2) ratings of severity of the complaints also by a psychiatric test nurse, and (3) completion of self-report instruments by the patients at baseline. Subsequently, every three to four months the rating of severity of complaints and administration of self-report measures is repeated in order to assess treatment outcome (see above). All patients complete generic instruments, such as the Brief Symptom Inventory (BSI, an abbreviated version of the SCL-90) and all are assessed by the Montgomery Asberg Depression Rating Scale (MADRS), the Brief Scale for Anxiety (BSA), Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF). In addition, for subsets of patients disorder specific measures are applied, such as the Beck Depression Inventory (BDI-II), the PADUA inventory for Obsessive Compulsive Disorder, or the Panic Disorder Severity Scale for panic Disorder. All assessment measures used are standardised instruments selected on their good psychometric properties. They are also clinically relevant and are commonly used in randomised clinical trials that are reported on in the research literature. Special precautions are taken to avoid missing data by using touch-screens to facilitate the assessments and to prevent skipping questions. All data obtained by Routine Outcome Monitoring are gathered in a central database, the Psychiatric Academic REgistration Leiden (PAREL). In July 2005 PAREL will contain data of over 2300 patients. In this study PAREL will be used as outcomes database. PAREL contains data regarding the psychiatric symptoms of patients with common psychiatric disorders (mood, anxiety, and somatoform disorders; the latter won?t be included in this research project ). In addition, the database comprises information on the kind of treatment that is delivered between assessments, by whom and at which location. These data are all collected prospectively. Additional data on therapist and patient characteristics are either already Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 6

7 Subsidieaanvraagformulier / Grant Application Form available in the database (e.g. personality characteristics of patient, as measured by the Dimensional Assessment of Personality Pathology; DAPP, complexity in terms of comorbid Axis I diagnoses) or will be added retrospectively, based on the patients files at the treatment centres or on information to be obtained from therapist (e.g. affiliation). A full representation of the tests used for this research: 1. Therapist Characteristics (Affiliation, age,years of experience) 2. Treatment characteristics (Psychiatric/psychosocial, number of sessions) 3. MINI 4. Patient demographics 5. Dimensional Assessment of Personality Psychopathology (DAPP) 6. Brief Symptom Inventory (BSI) 7. Montgomery Asberg Depression Rating Scale (MADRS) 8. Brief Scale for Anxiety (BSA) 9. Brief Symptom Inventory (BSI) 10. Disorder specific measures, such as: 11. Beck Depression Inventory Revised (BDI-II) 12. PADUA inventory for Obsessive Compulsive Disorder 13. Panic Disorder Severity Scale (PDSS) Aanvraagnummer / Application number: 4287 DEFINITIEF THE ANALYSES For the present project proposal data will be used from the start of Routine Outcome Monitoring till the end of It is expected that at that time treatment outcome data from 3000 patients will be available. These data allow for the assessment of treatment outcome in clinical practice. Treatment gain will be assessed from baseline to each subsequent assessment, can be expressed in standard units (delineating mean effect size), and thus compared to pre-post test differences as found in randomised controlled trials and published in the most recent international meta-analyses. In addition, because standardised measures have been used, criteria for clinically significant change will be applied to assess the proportion of patients that can be considered reliably improved and recovered (or reliably deteriorated or experiencing a relapse). To address the first research question pertaining to effectiveness of treatments delivered in clinical practice as compared to RCT outcomes, patients will be grouped according to treatment modality (pharmacological treatment, psychosocial treatment or the combination of both). For all patients who suffered at baseline from mood and/or anxiety disorders and whose treatment has been completed, the standardised mean difference from pre-test to last available post-test score on the Brief Symptom Inventory (BSI) will be assessed. Thus, for three groups of treatments outcomes will be available and these outcomes will be compared to findings from meta-analytic studies or RCT's evaluating the efficacy of treatments for mood- and anxiety disorders. The sensitivity of measurement instruments to change over time (treatment gain) varies. Special care will be taken to compare PAREL outcomes with outcomes in RCT's on identical measurement instruments for specific subgroups of patients (e.g., subgroups with specific disorders). In addition, the proportion of improved and recovered patients among these three groups will be assessed according to criteria of Jacobson and Truax (1991). These proportions will be compared to outcomes of RCT's as well. To address the second research question pertaining to patient, therapist, and treatment factors related to treatment gain (e.g. symptom reduction as assessed with the optimal test instrument) in clinical practice, for each group of factors a number of relevant variables will be investigated. The following variables will be investigated: Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 7

8 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF 1. Complexity of the psychopathology is the primary patient factor to be investigated, since this is claimed to be the main feature that distinguishes patients in clinical practice from patients who are typically selected to partake in RCT's. To investigate patient factors, first subgroups of patients will be discerned based on diagnostic status at baseline. Patients with a single diagnosis of mood disorder, a single diagnosis of anxiety disorder and comorbid cases will be compared regarding treatment outcome. It is expected that comorbid cases will show less treatment gain. Also, the number of diagnoses at baseline will be used as an indicator of complexity of the psychopathology. 2. An additional complexity factor to be studied is personality psychopathology as assessed by the DAPP. 3. Finally, ethnicity and co-medication use will be investigated as patient factors. The size of the data set allows for analysis of the prognostic effect of these factors pertaining to complexity of the patient in a single regression analysis with treatment outcome (residual gain score) as dependent variable and patient factors as predictors. Again, it is expected that complexity will be negatively associated with treatment gain. Treatment gain will be operationalized in two ways and analysed in two waves. First, treatment outcome will be defined according to criteria of Jacobson et al. (not changed, improved, and recovered) and predictors will be analysed with logistic regression. Next, treatment gain will be operationalized as the residual gain score (pre- to post-test difference corrected for initial level) on the BSI total score and predictors will be analysed with hierarchical regression analysis. Therapist factors to be evaluated as predictive for treatment outcome are years of experience, size of caseload, employment status (full vs. part-time), affiliation, and commitment to guidelines for good clinical practice. To assess this last aspect we developed a questionnaire, the Attitude on Routine Outcomes Monitoring And Guidelines (AROMAG). Treatment factors are to what extent treatments have been delivered according to guidelines for treatment for mood or anxiety disorders. These guidelines have been published recently in the Netherlands and have been implemented in the mental health field. Specific factors that will be evaluated on their association with treatment outcome are duration, frequency of sessions, and the administration of medication (dosage, commencement, tapering off). Also for this aspect we developed an instrument, the Treatment Integrity Checklist (TIC). When extensive additional data have to be gathered (e.g. regarding the treatment that was delivered) subgroups of patients will be selected that are representative for the entire sample of Expertise, voorgaande activiteiten en producten / Expertise, prior activities and products Zitman was involved in several research projects on the effectivity of treatments. He participated in several studies on the treatment of depression in primary care based on the prospectively gathered data of the Continuous Morbidity Registry of the department of General Practice of UMC-st Radboud in Nijmegen. In a second series of studies the diagnostic process of mental disorders in primary care was evaluated. He also was involved in several studies on patient and physician factors related to long-term prescription and discontinuation of benzodiazepines. De Beurs has ample experience with treatment outcome research in the Netherlands (de Beurs et al, Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 8

9 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF 1995) and the US (Goldstein et al, 2000). Furthermore, he was involved in setting up databases for outcome research in Amsterdam (Department of Psychiatry, VU and GGZBuitenamstel) and Leiden (Department of Psychiatry, LUMC and Rivierduinen). He has published several papers on methodological and measurement aspects of treatment outcome research. Publicaties / Publications Weel-Baumgarten EM, van den Bosch WJ, van den Hoogen HJ, Zitman FG. The validity of the diagnosis of depression in general practice: is using criteria for diagnosis as a routine the answer? Br J Gen Pract 2000; 50(453): Zitman FG, Couvee JE. Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group. Br J Psychiatry 2001; 178: Couvée JE, Timmermans EAY, Zitman FG. Longitudinal evaluation of prescription of psycho-active medication unto 3.5 years after taking part in a benzodiazepine discontinuation program in depressed chronic users (in Dutch general practice) J Aff Disorders 2002;70: de Beurs, E, Chambless DL, Goldstein, AJ. The match-mismatch model and panic patients' accuracy in predicting naturally occurring panic attacks. Depression and Anxiety 2002; 16: Beekman, ATF, Geerlings, SW, Deeg, DJH, Smit JH, Schoevers RS, de Beurs E et al. The natural history of late-life depression - A 6-year prospective study in the community. Archives of General Psychiatry 2002; 59: de Beurs, E, van Balkom AJLM, Van Dyck R, Lange A. Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: A two year naturalistic follow-up. Acta Psychiatrica Scandinavica 1999; 99(1): Referenties / References Ellwood, P. M. (1988). Shattuck lecture--outcomes management. A technology of patient experience. N Engl J Med, 318, Gilbody, S. M., House, A. O., & Sheldon, T. A. (2002). Outcomes research in mental health: Systematic review. The British Journal of Psychiatry, 181, Hotopf, M. (2002). The pragmatic randomised controlled trial. Adv Psychiatr Treat, 8, Jacobson, N. S. & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, Rosenheck, R., Fontana, A., & Stolar, M. (1999a). Assessing quality of care: administrative indicators and clinical outcomes in posttraumatic stress disorder. Med Care, 37, Rosenheck, R., Fontana, A., & Stolar, M. (1999b). Assessing quality of care: administrative indicators and clinical outcomes in posttraumatic stress disorder. Med Care, 37, Rosenheck, R., Fontana, A., & Stolar, M. (1999c). Assessing quality of care: administrative indicators and clinical outcomes in posttraumatic stress disorder. Med Care, 37, Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 9

10 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF Weiden PJ, Olfson M (1195) Cost of relapse in schizophrenia. Schizophr. Bull 21: Financiële gegevens / Financial data Geplande duur in maanden / Planned duration in months 48 maanden / months ZonMw budget Jaar / Year Kostenpost / Cost item Totaal / Total Personeel Materieel Implementatie Apparatuur Overig Totaal / Total Co-financiering / Cofinancing Naam co-financier / Name of cofinancier Rivierduinen LEIDEN Bedrag / Amount Status Toegekend 5. Bijzondere gegevens / Additional information Vergunningen / Permits Vergunning nodig / Permit required? Vergunning verkregen / Permit obtained? Ja / Yes Nee / No Ja / Yes Nee / No METC/DEC X X WBO X X Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 10

11 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 DEFINITIEF Biohazards X X Andere vergunningen / Other permits Niet van toepassing Historie subsidieaanvraag / History grant application Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 11

12 Subsidieaanvraagformulier / Grant Application Form Aanvraagnummer / Application number: 4287 Ondertekening / Signatures DEFINITIEF Naam Penvoerder-projectleider: F.G. Zitman Plaats en datum: Naam bestuurlijk verantwoordelijke: C.J. Witte Plaats en datum: Handtekening: Handtekening: Aangemaakt door ProjectNet / Generated by ProjectNet: :30 p. 12

13 promotiekosten 3000 Dit document dient u om te zetten naar PDF en via ProjectNet mee te sturen. C:\Documents and Settings\Eigenaar\Mijn documenten\subsidie leiden\bijlagen subsidieronde 2\uitgebreide_begroting.doc

14 Apparatuurkosten Jaar Functie /Omschrijving Not applicable Totaal Totaal : Overige kosten Jaar Functie /Omschrijving Not applicable Totaal Totaal : Begroting opleidingskosten Zonmw onderscheidt als opleidingsactiviteiten: cursussen, congresbezoek en promotiekosten. Geeft per activiteit weer welke kosten u denkt te maken. Het totaal aan opgevoerde kosten mag niet hoger zijn dan Euro. Type activiteit activiteit Kosten Cursussen (uit algemeen en specifiek deel opleidingsplan) 1 Epidemiologie algemeen Principes van epidemiologische data-analyse Inleiding SPSS Psychiatrische Epidemiologie Doelmatigheidsonderzoek Cursus Outcomes Research (University College of London) Congresbezoek (uit algemeen en specifiek deel opleidingsplan) Voorjaarscongres NVvP APA Verenigde Staten (2008, 2009) Overig Neem de kosten over uit de bijlage Aanvullende informatie kandidaat, werk- en opleidingsplan C:\Documents and Settings\Eigenaar\Mijn documenten\subsidie leiden\bijlagen subsidieronde 2\uitgebreide_begroting.doc

15 Jaar Functie /Omschrijving financier)draagt zorg voor implementatie van het onderzoek Totaal Totaal : C:\Documents and Settings\Eigenaar\Mijn documenten\subsidie leiden\bijlagen subsidieronde 2\uitgebreide_begroting.doc

16 OOG3 Bijlage Uitgebreide begroting Bij uw aanvraag dient u een uitgebreide begroting op te geven. Hieronder vindt uw diverse posten die een nadere uitwerking vragen. De onderstaande specificatie geldt alleen voor het ZonMw deel van de begroting en niet voor de andere financiering. Personeel Jaar Functie /Omschrijving Psychiater 24 u/week Rivierduinen (cofinancier) draagt zorg voor overig personeel: 12 testverpleegkundig en Totaal x x x x (4 x 25000) Totaal : Materiele kosten Jaar Omschrijving Not applicable Rivierduinen (cofinancier) draagt zorg voor de infrastructuur: computers, touchscreens en testruimtes op 6 locaties Totaal Totaal : Implementatiekosten Jaar Totaal Functie /Omschrijving Rivierduinen (co- C:\Documents and Settings\Eigenaar\Mijn documenten\subsidie leiden\bijlagen subsidieronde 2\uitgebreide_begroting.doc

17 Artikelen Nationaal: Voordelen van een multidisciplinaire aanpak bij chronische buikpijn Klinische les; PatientCare, april 2000, 1 e auteur. Competenties van aios psychiatrie op het gebied van psychiatrisch onderzoek (werktitel, in preparation, 1 e auteur) Competenties in psychiatrisch onderzoek op de spoedeisende hulp (werktitel, in preparation, 1 e auteur) Internationaal: Competencies in Psychiatry of residents in the ER (werktitel, in preparation, 1 e auteur) Persoonlijke Gegevens Geboortedatum: 11 juli 1974 Nationaliteit: Nederlandse Burgerlijke Staat: Ongehuwd, Samenwonend Adres: Stadhoudersweg 140-c 3039 CM Rotterdam Telefoon: (privé) (werk) rosalindvdlem@planet.nl (privé) r.vanderlem@erasmusmc.nl (werk)

18 AGIO Psychiatrie, 4 e jaar Parnassia, locatie Albardastraat, Stage Sociale Psychiatrie Den Haag, Zuid-Holland, tm AGIO Psychiatrie, 5 e jaar Erasmus MC, afdeling Consultatieve Dienst, keuzestage Rotterdam, Zuid-Holland, tm Wetenschappelijke ervaring 1996 Wetenschappelijke stage Kinderneurologie AZG 1996 Wetenschappelijke stage University of Pennsylvania; onderzoek naar taalbegrip in Alzheimer patiënten 2003 Start onderzoek : Psychiatrische vaardigheden van artsassistenten werkzaam op spoedeisende hulp Hobby s Toneel: Productie, Regie, Jeugdtheater Fotografie Vrijwilligerswerk: Thuiszorg Gehandicapten. Opleidingsgerelateerd: voorzitter assistentenvereniging HLOCP Publicaties Abstracts: Verb and Noun Comprehension in Frontotemporal Dementia Abstract op Multidisciplinary Conference on Pick s Disease & Frontotemporal Dementias, Philadelphia, Pennsylvania, USA Mei 6-7, 1999, 1e auteur Comprehension of Verbs and Nouns in Alzheimer s Disease Abstract op AAN Scientific Program 1999, 1e auteur Posterpresentatie Psychiatrisch onderzoek: geen enkel probleem?! M.m.v. drs. M. de Boo, drs. M. v. Vreeswijk, prof. Dr. MW Hengeveld. Wetenschappelijke voordracht Psychiatrie op de SEH, Voorjaarscongres 2005 Ervaren en gemeten competenties in psychiatrisch onderzoek van artsen werkzaam op de spoedeisende hulp M.m.v. drs. M. de Boo, drs. M. v. Vreeswijk, prof. dr. MW Hengeveld.

19 Curriculum Vitae Opleiding 1992 VWO Nienoordcollege te Leek, cum laude 1993 Propedeuse Geneeskunde, Rijksuniversiteit Groningen (RUG), cum laude 1997 Doctoraal examen Geneeskunde, RUG 1999 Artsexamen, RUG, cum laude 1996 Wetenschappelijke stage Kinderneurologie AZG Wetenschappelijk onderzoek, Cognitive Neurology, Upenn, Philadelphia, USA. Winnaar Penn-prijs voor onderzoeksvoorstel 2001 Start opleiding psychiatrie HLOCP Congressen: Voorjaarscongres 2002, 2003, 2005 Wat bezielt de Psychiatrie? 2003 APA 2004 Shared Care Congress 2005 Cursus: Teach the Clinical Teachers, najaar 2005, Boerhaave commissie Nascholing Farmacokinetiek, September 2005 Werkervaring AGNIO Psychiatrie GGZ Delfland, locatie Reinier de Graafweg Delft, Zuid-Holland, tm AGNIO Neurologie Sint Franciscus Gasthuis Rotterdam, Zuid-Holland, tm AGIO Psychiatrie, 1 e jaar Parnassia, locatie Monsterseweg, afdeling TMW open Den Haag, Zuid-Holland, tm AGIO Psychiatrie, 2 e jaar GGZ Delfland, locatie Jorisweg, afdeling A1 & B1 Delft, Zuid-Holland, tm AGIO Psychiatrie, 3 e jaar GGZ Delfland, locatie de Gravin, poli DW Delft, Zuid-Holland, tm AGIO Psychiatrie, 4 e jaar Parnassia, locatie Monsterseweg, afd. CIB, keuzestage Den Haag, Zuid-Holland, tm

20 3. Wat onderscheidt volgens u een wetenschappelijk onderzoeker van een klinisch onderzoeker? Een wetenschappelijk onderzoeker kan zich bezig houden met meer basale wetenschappen als genetica, biologie, psychologie of filosofie. Dit onderzoek kan ver af liggen van de praktische patiëntenzorg. Een klinisch onderzoeker zal op een wetenschappelijke manier vragen onderzoeken die ontstaan zijn vanuit behandeling of diagnostiek van patiënten met een bepaald ziektebeeld. Dit maakt het onderzoek meer praktijkgericht en geschikt voor meer directe consequenties voor behandeling van patiënten in de dagelijkse praktijk. 4. Hoe ziet u uw carrière op langere termijn wat betreft uw onderzoeks- en/of klinische ambities? Na het promotieonderzoek wat in deze aanvraag uiteen wordt gezet, zou ik graag de combinatie wetenschappelijk onderzoek en patiëntenzorg blijven combineren en me wetenschappelijk blijven verdiepen in vragen die diagnostiek en behandeling van patiënten in de dagelijkse praktijk oproepen. Ik zou graag de effectiviteit van behandelingen in de klinische praktijk willen blijven onderzoeken en andere GGZ-instellingen en hun medewerkers stimuleren hierin te participeren. Hierdoor is het voor mij mogelijk een brugfunctie te vervullen tussen de klinische praktijk: het veld en de universiteit. Ook zou ik me graag bezig houden met onderwijs aan arts-assistenten of medisch studenten om interesse in het vak psychiatrie gecombineerd met evidence based werken door te geven. Dit zou goed mogelijk zijn vanuit een GGZ instelling die gelieerd is aan een universiteit en daar goede samenwerkingsverbanden mee heeft. Ik vind het daarbij belangrijk dat de betreffende GGZ instelling ook is opgenomen in een opleidingsconsortium psychiatrie (zoals Rivierduinen) omdat dit kennisoverdracht en wetenschappelijke belangstelling bevordert.