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.
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.
Croudace
Tim
T
Department of Psychiatry University of Cambridge, UK.
Evans
Jonathan
J
Harrison
Glynn
G
Sharp
Deborah J
DJ
Wilkinson
Ellen
E
McCann
Gemma
G
Spence
Mathew
M
Crilly
Catherine
C
Brindle
Lucy
L
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