Best practices: dissemination of guidelines for the treatment of major depression in a managed behavioral health care network.

Abstract

tinuous quality improvement teams (7) have also been shown to be more influential in changing physicians’ behavior than education alone. However, given that most mental health specialists are unaffiliated, provide care in private offices, and belong to numerous open managed care networks, it would be unrealistic to rely on the use of academic detailing and continuous quality improvement in large decentralized delivery systems. Few studies of effective dissemination of guidelines as a strategy for influencing psychiatrists’ clinical practice have been published, and there have been no studies of nonphysician mental health practitioners. Managed behavioral health organizations (MBHOs) provided coverage to 176 million people (8) in 1999. They are thus in a unique position in the mental health services system to study clinicians’ behavior in realworld settings. Studying dissemination of guidelines in an MBHO provides access to a large population of patients throughout the United States who are treated by a representative sample of independent clinicians who have different backgrounds and clinical experience. We sought to determine whether clinicians read guidelines disseminated by MBHOs and, if so, whether they find such guidelines helpful.