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We would like to thank Dr. Hummel for her valuable comments and are delighted about her positive feedback. Contrary to her view, our understanding is that the intervention does not target younger and healthier patients but patients typically seen in GP practices. Exclusion criteria, such as an upper age limit or physical illnesses, were deliberately omitted (1, 2); likewise, patients with moderate cognitive deficits or prolonged benzodiazepine dependence were not excluded from the study. Thus, almost all patients had comorbidities and 79.8% of patients experienced pain. Patients aged ≥ 75 years (n = 93) accounted for 37.5% of the study population which shows that not only “young elderly” were reached.

Dr. Hummel’s question regarding the PHQ scores can be answered as follows: Because of the interval of 3 weeks on average between screening in the GP practice and inclusion in the study, lower PHQ scores at baseline were obtain in some of the subjects. Indeed, 5.6% (14 patients) had a PHQ score <5.

The high percentage of non-remitting patients—both in the control group and the intervention group—demonstrates the chronic nature of depression in the elderly.

Patients of both groups had access to all treatment options available on an outpatient basis; the organizers of the study did not offer any special services.

The option to drop out of the study and start a guideline psychotherapy was only used by 6 of the altogether 248 participants.

We agree that it would be valuable to extend the stepwise treatment program by a further step, e.g. guideline psychotherapy or inpatient care, to be offered to elderly patients with severe or chronic depression. However, this implementation study initially addressed only the low-threshold access to psychiatric care/psychotherapy and confirmed the effectiveness demonstrated in similar studies conducted in other health systems, which is important for the development of corresponding healthcare offerings.

DOI: 10.3238/arztebl.2019.0144b

Dr. phil. Lars P. Hölzel
Klinik für Psychiatrie und Psychotherapie
Universitätsklinikum Freiburg, Medizinische Fakultät,
Albert-Ludwigs-Universität Freiburg
Parkklinik Wiesbaden Schlangenbad, Schlangenbad, Germany
hoelzel@parkklinik-schlangenbad.de

Prof. Dr. phil. Dr. med. Martin Härter
Institut und Poliklinik für Medizinische Psychologie
Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

Dr. rer. biol. hum. Thomas Kloppe
Institut und Poliklinik für Allgemeinmedizin
Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

Prof. Dr. med. Michael Hüll
Klinik für Alterspsychiatrie- und psychotherapie
Zentrum für Psychiatrie und Psychotherapie, Emmendingen, Germany

Conflict of interest

The authors declare that no conflict of interest exists.

1.
Hölzel LP, Bjerregaard F, Bleich C, et al.: Coordinated treatment of depression in elderly people in primary care—a cluster-randomized, controlled study (GermanIMPACT). Dtsch Arztebl Int 2018; 115: 741–7. VOLLTEXT
2.
Wernher I, Bjerregaard F, Tinsel I, et al.: Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial. Trials 2014; 15: 351 CrossRef MEDLINE PubMed Central
1.Hölzel LP, Bjerregaard F, Bleich C, et al.: Coordinated treatment of depression in elderly people in primary care—a cluster-randomized, controlled study (GermanIMPACT). Dtsch Arztebl Int 2018; 115: 741–7. VOLLTEXT
2.Wernher I, Bjerregaard F, Tinsel I, et al.: Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial. Trials 2014; 15: 351 CrossRef MEDLINE PubMed Central

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