title: Systematic tailoring for the implementation of guideline recommendations for anxiety and depressive disorders in general practice: perceived usefulness of tailored interventions.
abstract: BACKGROUND
  The uptake of guideline recommendations in general practice can potentially be improved by designing implementation interventions that are tailored to prospectively identify barriers. However, there is insufficient evidence regarding the most effective and efficient approaches to tailoring. Our study provides an insight into the usefulness of tailored interventions to prospectively identified barriers affecting the uptake of guideline recommendations for anxiety and depressive disorders experienced by general practitioners (GPs) in their local context.
  
  
  METHODS
  A qualitative study was conducted, in which 23 GPs gave informed consent and 14 finally participated. To explore the barriers affecting the uptake of guideline recommendations, a face-to-face interview was conducted with each GP to generate a personalised list. In response to this list, interventions were tailored to remove the barriers experienced by the GPs. To examine the perceived usefulness of the tailored interventions, telephone interviews were conducted after one year and coded through thematic coding. The analysis was descriptive in nature.
  
  
  RESULTS
  The most frequently perceived barriers were: a lack of knowledge and skills, no agreement on guideline recommendations, negative outcome expectancy, low self-efficacy, no consensus with patients, and a lack of information about treatments provided by mental health professionals, together with waiting lists. The tailored interventions 'peer group supervision' and 'individualised telephone consultations' were perceived as useful by most GPs. Besides the tailored interventions, a perceived benefit of using a self-rating scale, measuring depressive and anxiety symptoms, and the idea of delivering better patient care, were supportive in the uptake of guideline recommendations.
  
  
  CONCLUSIONS
  Our findings suggest that tailoring interventions to prospectively identified barriers, affecting the uptake of guideline recommendations for anxiety and depressive disorders, as perceived by GPs, may enhance the implementation of these guideline recommendations.
authors.affiliation: Netherlands Institute of Mental Health and Addiction Trimbos Institute, Trimbos, The Netherlands. hsinnema@trimbos.nl
authors.forename: Henny
authors.initials: H
authors.lastname: Sinnema
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Volker
authors.forename: Gerdien
authors.initials: G
authors.lastname: Franx
authors.forename: Anton
authors.initials: A
authors.lastname: van Balkom
authors.forename: Jacomine
authors.initials: J
authors.lastname: de Lange
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy*; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D058006:General Practice; D017408:Guidelines as Topic; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged