Abstract
BackgroundAs compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care. To improve adherence to guideline recommendations on mental health problems, an implementation strategy was developed for Dutch occupational physicians (OPs). The aims were 1) to assess adherence to a mental health guideline in occupational health care and 2) to evaluate the effect of a tailored implementation strategy on guideline adherence compared to traditional guideline dissemination.MethodsAn audit of medical records was conducted as part of a larger RCT study. Participants were 66 OPs (32 intervention and 34 control) employed at one of six sites of an Occupational Health Service in southern Netherlands. OPs in the intervention group received multiple-session peer group training which focused on identifying and addressing barriers to using the guideline, using a Plan-Do-Check-Act approach. The control group did not receive training.Medical records of 114 workers sick-listed with mental health problems were assessed (56 intervention and 58 control). Guideline adherence was determined by auditing the records using 12 guideline-based performance indicators (PI), grouped into 5 PIs: process diagnosis, problem orientation, interventions/treatment, relapse prevention, and continuity of care. Differences in performance rates of the PIs between the intervention and control groups were analyzed, taking into account the cluster study design.ResultsOPs who received the training showed significantly greater adherence compared to the controls (p < .028) in 4 out of 5 grouped PIs, i.e. process diagnosis, problem orientation, interventions/treatment and relapse prevention. In one out of 12 PIs adherence was found adequate (53% of the medical records), in 6 PIs adherence was found minimal, and in 5 PIs the majority of the records showed no adherence.ConclusionsAn implementation strategy which addressed key barriers for change and tailor-made interventions improves adherence to an occupational health guideline for mental health problems compared to traditional guideline dissemination. However, adherence to the guideline recommendations is still far from optimal. To optimize adherence, it is recommended that implementation strategies focus on the workers level, organizational level, and the professional level.Trial registrationISRCTN86605310. Registered 30 June 2010.
Highlights
As compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care
An implementation strategy which addressed key barriers for change and tailor-made interventions improves adherence to an occupational health guideline for mental health problems compared to traditional guideline dissemination
It is recommended that implementation strategies focus on the workers level, organizational level, and the professional level
Summary
As compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care. The aims were 1) to assess adherence to a mental health guideline in occupational health care and 2) to evaluate the effect of a tailored implementation strategy on guideline adherence compared to traditional guideline dissemination. Many studies have demonstrated a lack of compliance to guidelines [5, 6] As a result, it remains unclear whether practice guidelines have any impact on the performance of the providers and on outcomes on patient level [7]. To be effective in improving adherence, active strategies are needed that aim to eliminate barriers that hinder professionals from adhering to a specific guideline [11]. It is recommended to use implementation strategies tailored to the needs of the target group to overcome perceived barriers of specific guideline recommendations [11, 13]
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