Abstract
BackgroundThe gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects.The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation.MethodsSix psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study.ResultsThe documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months.ConclusionsCompliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance.
Highlights
The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread
Quality indicators derived from the clinical guidelines were used to study compliance
The documentation of the quality indicators improved from the baseline in the four clinics where implementation was carried out, whereas there were no changes, or a decline, in the documentation of most quality indicators in those without implementation
Summary
The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Transferring research results into routine clinical practice is complicated; several studies have described implementation difficulties and the complexity of achieving performance change in health care [1,2]. Knowledge about effective implementation strategies has increased their use, it has mostly only resulted in small to moderate improvements. There is a gap between evidence-based knowledge and current practice in many medical areas [9,12], and how best to implement guidelines into routine care remains unclear [13]. Implementation of guidelines mostly entails complex interventions, and effective interventions are often elaborated in complicated procedures [14,15]. Evaluated multifaceted implementation strategies are audits and feedback, reminders, and educational outreach [2]
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