title: Determinants of adherence to recommendations for depressed elderly patients in primary care: a multi-methods study.
abstract: OBJECTIVE
  It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression.
  
  
  METHODS
  Group and individual interviews and a survey were conducted in Norway.
  
  
  METHODS
  Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants.
  
  
  METHODS
  Physicians and nurses from primary and specialist care, psychologists, researchers, and patients.
  
  
  METHODS
  Determinants of adherence to recommendations for depressed elderly patients in primary care.
  
  
  RESULTS
  A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners' time constraints, the low prioritization of elderly patients with depression, and the patients' or relatives' wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions.
  
  
  CONCLUSIONS
  The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.
authors.affiliation: Research Centre for Old Age Psychiatry, Innlandet Hospital Trust , Ottestad , Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Aakhus
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Oxman
authors.forename: Signe A
authors.initials: SA
authors.lastname: Flottorp
mesh_terms: D000368:Aged; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D003866:Depressive Disorder / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D019983:Guideline Adherence; D006292:Health Priorities; D006801:Humans; D033181:Information Dissemination; D007407:Interviews as Topic; D008297:Male; D009664:Norway; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D013997:Time Factors
keywords: Depression; Norway; determinants of practice; elderly patients; general practice; primary care; tailored implementation