Major depressive disorders in the general hospital: how to implement guidelines.
OBJECTIVE
An implementation study that evaluated the impact of previously adopted guidelines on the clinical practice of medical residents was conducted to improve the recognition and treatment of major depressive disorders (MDDs) in hospitalized patients with somatic diseases.


METHODS
Guidelines were implemented in two wards (ENT and oncology) using intranet diffusion, interactive sessions with medical residents, and support material. Discharge letters of 337 and 325 patients, before and after the intervention, respectively, were checked for statement of diagnosis or treatment of MDDs and, in a post hoc analysis, for any mention about psychiatric management.


RESULTS
No difference was found in the number of diagnosed or treated MDDs before and after the intervention. However, significantly more statements about psychological status (29/309 vs. 13/327) and its management (36/309 vs. 19/327) were observed after the intervention (P<.01).


CONCLUSIONS
The intervention was not successful in improving the management of MDDs. However, a possible effect on general psychological aspects of medical diseases was observed.
Michaud
Laurent
L
Clinical Epidemiology Center, Institute of Social and Preventive Medicine, University Hospital, Lausanne, Switzerland.
Voellinger
Rachel
R
Burnand
Bernard
B
Stiefel
Friedrich
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D017408:Guidelines as Topic; D006293:Health Promotion / Q000379:methods*; D006769:Hospitals, General; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires