title: Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.
abstract: BACKGROUND
  Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated.
  
  
  METHODS
  OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training.
  
  
  RESULTS
  The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01).
  
  
  CONCLUSIONS
  The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. m.c.w.joosen@tilburguniversity.edu.
authors.forename: Margot C W
authors.initials: MC
authors.lastname: Joosen
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. k.vanbeurden@tilburguniversity.edu.
authors.forename: Karlijn M
authors.initials: KM
authors.lastname: van Beurden
authors.affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. b.terluin@vumc.nl.
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. j.vanweeghel@tilburguniversity.edu.|Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands. j.vanweeghel@tilburguniversity.edu.|Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900, AH, Castricum, The Netherlands. j.vanweeghel@tilburguniversity.edu.
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. e.p.m.brouwers@tilburguniversity.edu.
authors.forename: Evelien P M
authors.initials: EP
authors.lastname: Brouwers
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. j.j.l.vdrklink@tilburguniversity.edu.|Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713, AV, Groningen, The Netherlands. j.j.l.vdrklink@tilburguniversity.edu.
authors.forename: Jac J L
authors.initials: JJ
authors.lastname: van der Klink
mesh_terms: D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009787:Occupational Medicine / Q000193:education* / Q000592:standards*; D010465:Perception; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D058996:Quality Improvement