title: Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial.
abstract: BACKGROUND
  Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.
  
  
  METHODS
  This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.
  
  
  CONCLUSIONS
  There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.
  
  
  BACKGROUND
  ISRCTN: ISRCTN83365316.
authors: Centro de Salud El Naranjo, Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain. mtello.gapm09@salud.madrid.org
authors: Eugenia
authors: E
authors: Tello-Bernabé
authors: Teresa
authors: T
authors: Sanz-Cuesta
authors: Isabel
authors: I
authors: del Cura-González
authors: María L
authors: ML
authors: de Santiago-Hernando
authors: Montserrat
authors: M
authors: Jurado-Sueiro
authors: Mercedes
authors: M
authors: Fernández-Girón
authors: Francisca
authors: F
authors: García-de Blas
authors: Higinio
authors: H
authors: Pensado-Freire
authors: Francisco
authors: F
authors: Góngora-Maldonado
authors: María J
authors: MJ
authors: de la Puente-Chamorro
authors: Carmen
authors: C
authors: Rodríguez-Pasamontes
authors: Susana
authors: S
authors: Martín-Iglesias
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D016000:Cluster Analysis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D011320:Primary Health Care / Q000458:organization & administration*; D013030:Spain; D055815:Young Adult