Effectiveness of a tailored implementation programme to improve recognition, diagnosis and treatment of anxiety and depression in general practice: a cluster randomised controlled trial

Abstract

BackgroundAnxiety and depression are not always diagnosed and treated in primary care as has been recommended. A tailored implementation programme, which addresses key barriers for change by targeted interventions, may help to remedy this.MethodsThe effectiveness of an individually tailored implementation programme, additional to standardised training and feedback on the recognition and treatment of patients with anxiety or depression in general practice, was examined in a cluster randomised controlled trial. Participants were 46 general practitioners (GPs) from 23 general practices (12 intervention, 11 control) and 444 patients aged 18 years or older (198 intervention, 246 control) who screened positive on the extended Kessler 10. In the control group, GPs received a 1-day training in guidelines for recognition and stepped treatment for anxiety and depression. Ten months after the training session, GPs received feedback on their performance over the preceding 6 months. In the intervention group, GPs received the same training and feedback as those in the control condition; in addition, they were offered support, tailored to perceived local barriers to change. The support was delivered in the format of peer group supervisions and personalised telephone consultations. Data were based on an audit of patient records and patient surveys at baseline and after 3 and 6 months.ResultsThe tailored implementation programme led to recognition of a higher proportion of patients presenting with anxiety and depression (42% versus 31%; odds ratio (OR) = 1.60; 95% CI: 1.01–2.53), more consultations after recognition (IRR = 1.78; 95% CI: 1.14–2.78) and did not lead to more prescription of antidepressants (OR = 1.07; 95% CI: 0.52–2.19) or referral to specialist mental health services (OR = 1.62; 95% CI: 0.72–3.64). Patients in the intervention group reported better accessibility of care (effect size (ES) = 0.4; p < 0.05) and provision of information and advice (ES = 0.5; p < 0.05).ConclusionsA tailored implementation programme may enhance the recognition and treatment of patients with anxiety or depression. Further development and evaluation of the programme is warranted to determine its cost-effectiveness.Trail registrationDutch Trial Register identifier NTR1912.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0210-8) contains supplementary material, which is available to authorized users.

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

“…From these, (4) the combination of educational meeting and audit/feedback was the most frequent with four studies. 27 42,45 (6) Eight studies used a multifaceted approach, combining more than two methods: distribution of materials, outreach visit and reminders 59 ; educational meetings, outreach visit and audit 28,36 ; outreach visit, audit and practice facilitation 35 ; educational meetings, audit and reminders 38 ; educational meetings, dissemination and networking 30 ; educational meetings, motivational interview and networking 51 ; educational meetings, reminders, audit and feedback, opinion leaders, financial reimbursement, patient-medicated interventions and distribution of educational material. 39 Three studies reported explicitly relying on a theory with regard to the tested intervention: the Theoretical Domains Framework and the Theory of Planned Behaviour, 34 the knowledge translation framework by the Canadian Institutes of Health Research 41 and the RE-AIM framework.…”

Real-world implementation of electronic patient-reported outcomes in outpatient pediatric cancer care

“…Adult oncology clinical trial studies have also described multiple challenges on integrating PRO data in daily care because of the complexity of the disease (eg, high attrition rates during treatment) . It is therefore important to assess which factors might influence the implementation process so that tailored implementation strategies can be developed …”

“…30,31 It is therefore important to assess which factors might influence the implementation process so that tailored implementation strategies can be developed. 29,32,33 The aim of the current study was (1) to determine the fidelity of the KLIK method during outpatient consultations shortly after childhood cancer diagnosis in terms of website registration, completion of HRQoL questionnaires, and discussion of KLIK ePROfiles, and (2) to study HCP-reported barriers and facilitators for implementation. First, all HCPs followed the KLIK training 34,35 and received their unique username and password.…”

Can the Use of Bayesian Analysis Methods Correct for Incompleteness in Electronic Health Records Diagnosis Data? Development of a Novel Method Using Simulated and Real-Life Clinical Data

“…Examples of the above scenarios are mental health conditions, such as anxiety and depression, stigmatized neurological conditions such as dementia, and chronic conditions which may have a "silent" onset, such as diabetes (18,19). Figures from a range of studies and two meta-analyses shown in Table 1, they show that estimated rates of under-diagnosis for dementia, depression and anxiety, average about 50% (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Further assessments of completeness of EHR data, such as the review by Chan et al (36), show that missingness of parameters such as blood pressure and smoking status can be as high as 38-51%, but are less likely to be missing in populations where these parameters are important for clinical care, such as a high risk cardiovascular disease cohort.…”