Which physician and practice characteristics are associated with adherence to evidence-based guidelines for depressive and anxiety disorders?
BACKGROUND
Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence.


OBJECTIVE
To investigate how practice- and professional-related factors are associated with adherence to these guidelines.


METHODS
Cross-sectional cohort study.


METHODS
A total of 665 patients with a composite interview diagnostic instrument diagnosis of depressive or anxiety disorders, and 62 general practitioners from 21 practices participated.


METHODS
Actual care data were derived from electronic medical record data. The measurement of guideline adherence was based on performance indicators derived from evidence-based guidelines. Practice-, professional-, and patient-related characteristics were measured with questionnaires. The characteristics associated with guideline adherence were assessed by multivariate multilevel regression analysis.


RESULTS
A number of practice and professional characteristics showed a significant univariate association with guideline adherence. The multivariate multilevel analyses revealed that, after controlling for patient characteristics, higher rates of guideline adherence were associated with stronger confidence in depression identification, less perceived time limitations, and less perceived barriers for guideline implementation. These professional-related determinants differed among the overall concept of guideline adherence and the various treatment options.


CONCLUSIONS
This study showed that rates of adherence to guidelines on depressive and anxiety disorders were not associated with practice characteristics, but to some extent with physician characteristics. Although most of the identified professional-related determinants are very difficult to change, our results give some directions for improving depression and anxiety care.
Smolders
Mirrian
M
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands. m.smolders@iq.umcn.nl
Laurant
Miranda
M
Verhaak
Peter
P
Prins
Marijn
M
van Marwijk
Harm
H
Penninx
Brenda
B
Wensing
Michel
M
Grol
Richard
R
D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors