Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice.
BACKGROUND
Various methods are available for implementing change in the clinical behaviour of general practitioners (GPs). Although passive dissemination of information is generally ineffective, other methods can be variably effective. Few studies have investigated the impact of tailored methods.


OBJECTIVE
To determine whether methods tailored to overcome obstacles to change using psychological theories are more effective than dissemination alone in the implementation of guidelines for depression among GPs.


METHODS
Randomised controlled trial.


METHODS
Sixty general practices in England; 30 GPs in the control group, 34 in the intervention group.


METHODS
Practitioners identified patients presenting with depression before and after the implementation of guidelines (control group n = 192 in the first data collection, n = 181 in the second; intervention group n = 210 in the first data collection and n = 197 in the second). The main outcome measures were: record of adherence to guideline recommendations in clinical records; proportion of patients with Beck Depression Inventory (BDI) score less than 11 at 16 weeks after diagnosis.


RESULTS
In comparison with the control group, in the group of GPs receiving tailored implementation, there were increases in the proportions of patients assessed for suicide risk. In the intervention group, the proportion of patients with BDI scores of less than 11 at 16 weeks increased.


CONCLUSIONS
Obstacles to implementation can be identified and strategies tailored to address them. The findings indicate a new approach for research to understand and develop methods of implementation.
Baker
R
R
Clinical Governance Research and Development Unit, Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW. rb14@le.ac.uk
Reddish
S
S
Robertson
N
N
Hearnshaw
H
H
Jones
B
B
D003866:Depressive Disorder / Q000628:therapy*; D005194:Family Practice / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales