The final selection of process indicators helps to measure
whether the first two or three recommended treatment steps have been followed in each condition, if indicated. For this study, the adequacy of psychotherapeutic treatment steps was assessed not only by looking at the percentage of patients receiving the right sort of treatment method. Three additional parameters were brought into the picture by using three supplementary help indicators, to measure the proper execution of each of these treatment steps. If the recommended psychotherapeutic treatment had been offered, these supplementary help indicators reflected: 1) whether a treatment rationale had also been given; 2) whether the
accompanying homework assignments had been provided during at least half the sessions, where relevant, and; 3) whether the minimum recommended number of treatment sessions had been provided. The adequacy of the pharmacological treatment was not only assessed by looking at the prescription of the right category of medication. Here, three types of supplementary help indicators were also used. If the recommended type of medicine was prescribed, these reflected: 1) whether one of the specific drugs mentioned in the guideline had also been chosen (e.g. fluoxetine as one of the recommended SSRIs for patients with panic disorder); 2) whether the recommended dosage was prescribed and; 3) whether the drug was maintained long enough to be able to evaluate effectiveness (to view an English translation of the final set of process indicators, and the corresponding supplementary help indicators see Additional file