The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization.
This study tests whether a managed behavioral health care organization can influence adherence to practice guidelines for the treatment of major depression in a randomized trial of guideline dissemination. Guidelines were disseminated to mental health clinicians (N = 443) under one of three conditions: (1) a general mailing of guidelines to clinicians, (2) a mailing in which guidelines were targeted to a patient starting treatment with the clinician, and (3) no mailing of guidelines. The results showed no effects of guideline dissemination as measured by self-report of patients and clinicians and through episode characteristics derived from claims data, despite sentinel effects. Results also showed high rates of clinician-reported guideline adherence that were not detected in the claims data, indicating significant undertreatment of depression. Results suggest that mental health systems must look to other dissemination strategies to improve adherence to standards of care and raise the performance of independent practicing clinicians.
Azocar
Francisca
F
Behavioral Health Sciences Department, United Behavioral Health, 425 Market Street, 27th Floor, San Francisco, CA 94105, USA. francisca_azocar@uhc.com
Cuffel
Brian
B
Goldman
William
W
McCarter
Loren
L
D019985:Benchmarking; D002985:Clinical Protocols; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D033181:Information Dissemination; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D017410:Practice Guidelines as Topic; D014481:United States