title: An implementation strategy to improve the guideline adherence of insurance physicians: an experiment in a controlled setting.
abstract: BACKGROUND
  The aim of this study was to investigate the efficacy of a newly developed implementation strategy for the insurance medicine guidelines for depression in the Netherlands. We hypothesized that an educational intervention would increase the insurance physicians' (IPs) guideline adherence in a controlled setting.
  
  
  METHODS
  Forty IPs were allocated in a randomised controlled trial (RCT) to an intervention group (IG) (n = 21) and a control group (CG) (n = 19). The IG received tailored training in applying the guidelines for depression, while the CG received an alternative programme. Baseline (T0) and follow-up (T1) measurements were conducted before and after the intervention within a period of two weeks. The intervention consisted of a workshop in which the evidence-based theory of the guidelines was translated for use in practice, with the help of various tools. The IPs had to write a case-report on the basis of video cases, two before and two after the training. Specially trained and blinded test IPs judged the case reports independently on the basis of six performance indicators. Primary outcome measure in the controlled setting of the trial was guideline adherence measured by six performance indicators on a scale of one to seven. Secondary outcome measure was knowledge of the guidelines for depression. Analyses were performed using Linear Mixed Models, and ANCOVA.
  
  
  RESULTS
  We found significantly higher scores in the IG than in the CG at T1 for both outcomes. The interaction effect (standard error; p-value) of group crossed with time was 0.97 (0.19; p < 0.0005) for guideline adherence in the controlled setting. The group effect at T1 for the knowledge test was 0.86 (0.40; p = 0.038).
  
  
  CONCLUSIONS
  The newly developed implementation strategy for the insurance medicine guidelines for depression improved the guideline adherence of the trained IPs in disability assessments of clients with depression when performed in a controlled setting. Furthermore, the trained IPs showed gains in knowledge of the guidelines for depression.
  
  
  BACKGROUND
  Netherlands' Trial Register NTR1863.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. f.zwerver@vumc.nl
authors.forename: Feico
authors.initials: F
authors.lastname: Zwerver
authors.forename: Antonius J M
authors.initials: AJ
authors.lastname: Schellart
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek
mesh_terms: D000704:Analysis of Variance; D003625:Data Collection; D004185:Disability Evaluation; D004493:Education; D004502:Education, Medical, Continuing; D004521:Educational Measurement; D004522:Educational Status; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D019359:Knowledge; D009426:Netherlands; D010820:Physicians; D010818:Practice Patterns, Physicians'; D016730:Program Development; D013223:Statistics as Topic