title: Randomised controlled trial of tailored interventions to improve the management of anxiety and depressive disorders in primary care.
abstract: BACKGROUND
  Anxiety and depressive disorders are highly prevalent disorders and are mostly treated in primary care. The management of these disorders by general practitioners is not always consistent with prevailing guidelines because of a variety of factors. Designing implementation strategies tailored to prospectively identified barriers could lead to more guideline-recommended care. Although tailoring of implementation strategies is promoted in practice, little is known about the effect on improving the quality of care for the early recognition, diagnosis, and stepped care treatment allocation in patients with anxiety or depressive disorders in general practice. This study examines whether the tailored strategy supplemented with training and feedback is more effective than providing training and feedback alone.
  
  
  METHODS
  In this cluster randomised controlled trial, a total of 22 general practices will be assigned to one of two conditions: (1) training, feedback, and tailored interventions and (2) training and feedback. The primary outcome measure is the proportion of patients who have been recognised to have anxiety and/or depressive disorder. The secondary outcome measures in patients are severity of anxiety and depressive symptoms, level of functioning, expectation towards and experience with care, quality of life, and economic costs. Measures are taken after the start of the intervention at baseline and at three- and six-month follow-ups. Secondary outcome measures in general practitioners are adherence to guideline-recommended care in care that has been delivered, the proportion of antidepressant prescriptions, and number of referrals to specialised mental healthcare facilities. Data will be gathered from the electronic medical patient records from the patients included in the study. In a process evaluation, the identification of barriers to change and the relations between prospectively identified barriers and improvement interventions selected for use will be described, as well as the factors that influence the provision of guideline-recommended care.
  
  
  CONCLUSIONS
  It is hypothesised that the adherence to guideline recommendations will be improved by designing implementation interventions that are tailored to prospectively identified barriers in the local context of general practitioners. Currently, there is insufficient evidence on the most effective and efficient approaches to tailoring, including how barriers should be identified and how interventions should be selected to address the barriers.
  
  
  BACKGROUND
  NTR1912.
authors.affiliation: Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, the Netherlands. hsinnema@trimbos.nl.
authors.forename: Henny
authors.initials: H
authors.lastname: Sinnema
authors.forename: Gerdien
authors.initials: G
authors.lastname: Franx
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Volker
authors.forename: Cristina
authors.initials: C
authors.lastname: Majo
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Anton
authors.initials: A
authors.lastname: van Balkom
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D016000:Cluster Analysis; D003625:Data Collection; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome