title: Impact of the ICD-10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care. Cluster randomised controlled trial.
abstract: BACKGROUND
  The World Health Organization (WHO) ICD-10 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (1996) have not been evaluated in a pragmatic randomised controlled trial (RCT).
  
  
  OBJECTIVE
  To evaluate the effect of local adaptation and dissemination of the guidelines.
  
  
  METHODS
  Pragmatic, pair-matched, cluster RCT involving 30 practices.
  
  
  RESULTS
  Guideline practices were less sensitive but more specific in identifying morbidity, but these differences were not significant. Guideline patients did not differ from usual-care patients on 12-item General Health Questionnaire scores at 3-month follow-up or in the proportion who were still cases. There were no significant differences in secondary outcomes.
  
  
  CONCLUSIONS
  Attempts to influence clinician behaviour through a process of adaptation and extension of guidelines are unlikely to change detection rates or outcomes.
authors.affiliation: Department of Psychiatry University of Cambridge, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Croudace
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Glynn
authors.initials: G
authors.lastname: Harrison
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: Ellen
authors.initials: E
authors.lastname: Wilkinson
authors.forename: Gemma
authors.initials: G
authors.lastname: McCann
authors.forename: Mathew
authors.initials: M
authors.lastname: Spence
authors.forename: Catherine
authors.initials: C
authors.lastname: Crilly
authors.forename: Lucy
authors.initials: L
authors.lastname: Brindle
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D004185:Disability Evaluation; D005194:Family Practice / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D033181:Information Dissemination; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014944:World Health Organization