title: Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up.
abstract: BACKGROUND
  The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects.The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation.
  
  
  METHODS
  Six psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study.
  
  
  RESULTS
  The documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months.
  
  
  CONCLUSIONS
  Compliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden. tord.forsner@ki.se
authors.forename: Tord
authors.initials: T
authors.lastname: Forsner
authors.forename: Anna Aberg
authors.initials: AA
authors.lastname: Wistedt
authors.forename: Mats
authors.initials: M
authors.lastname: Brommels
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.forename: Antonio Ponce
authors.initials: AP
authors.lastname: de Leon
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Forsell