TY - JOUR
T1 - Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care
AU - Joosen, M.C.W.
AU - van Beurden, K.M.
AU - Rebergen, D.S.
AU - Loo, M.A.J.M.
AU - Terluin, B.
AU - van Weeghel, J.
AU - van der Klink, J.J.L.
AU - Brouwers, E.P.M.
N1 - Funding
This study was financially supported by the Netherlands Organisation for Health Research and Development (ZonMw) (grant number 208030001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Trail registration: ISRCTN86605310.
PY - 2019
Y1 - 2019
N2 - Background: As compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care. To improve adherence to guideline recommendations on mental health problems, an implementation strategy was developed for Dutch occupational physicians (OPs). The aims were 1) to assess adherence to a mental health guideline in occupational health care and 2) to evaluate the effect of a tailored implementation strategy on guideline adherence compared to traditional guideline dissemination.Methods: An audit of medical records was conducted as part of a larger RCT study. Participants were 66 OPs (32 intervention and 34 control) employed at one of six sites of an Occupational Health Service in southern Netherlands. OPs in the intervention group received multiple-session peer group training which focused on identifying and addressing barriers to using the guideline, using a Plan-Do-Check-Act approach. The control group did not receive training.Medical records of 114 workers sick-listed with mental health problems were assessed (56 intervention and 58 control). Guideline adherence was determined by auditing the records using 12 guideline-based performance indicators (PI), grouped into 5 PIs: process diagnosis, problem orientation, interventions/treatment, relapse prevention, and continuity of care. Differences in performance rates of the PIs between the intervention and control groups were analyzed, taking into account the cluster study design.Results: OPs who received the training showed significantly greater adherence compared to the controls (p < .028) in 4 out of 5 grouped PIs, i.e. process diagnosis, problem orientation, interventions/treatment and relapse prevention. In one out of 12 PIs adherence was found adequate (53% of the medical records), in 6 PIs adherence was found minimal, and in 5 PIs the majority of the records showed no adherence.Conclusions: An implementation strategy which addressed key barriers for change and tailor-made interventions improves adherence to an occupational health guideline for mental health problems compared to traditional guideline dissemination. However, adherence to the guideline recommendations is still far from optimal. To optimize adherence, it is recommended that implementation strategies focus on the workers level, organizational level, and the professional level.
AB - Background: As compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care. To improve adherence to guideline recommendations on mental health problems, an implementation strategy was developed for Dutch occupational physicians (OPs). The aims were 1) to assess adherence to a mental health guideline in occupational health care and 2) to evaluate the effect of a tailored implementation strategy on guideline adherence compared to traditional guideline dissemination.Methods: An audit of medical records was conducted as part of a larger RCT study. Participants were 66 OPs (32 intervention and 34 control) employed at one of six sites of an Occupational Health Service in southern Netherlands. OPs in the intervention group received multiple-session peer group training which focused on identifying and addressing barriers to using the guideline, using a Plan-Do-Check-Act approach. The control group did not receive training.Medical records of 114 workers sick-listed with mental health problems were assessed (56 intervention and 58 control). Guideline adherence was determined by auditing the records using 12 guideline-based performance indicators (PI), grouped into 5 PIs: process diagnosis, problem orientation, interventions/treatment, relapse prevention, and continuity of care. Differences in performance rates of the PIs between the intervention and control groups were analyzed, taking into account the cluster study design.Results: OPs who received the training showed significantly greater adherence compared to the controls (p < .028) in 4 out of 5 grouped PIs, i.e. process diagnosis, problem orientation, interventions/treatment and relapse prevention. In one out of 12 PIs adherence was found adequate (53% of the medical records), in 6 PIs adherence was found minimal, and in 5 PIs the majority of the records showed no adherence.Conclusions: An implementation strategy which addressed key barriers for change and tailor-made interventions improves adherence to an occupational health guideline for mental health problems compared to traditional guideline dissemination. However, adherence to the guideline recommendations is still far from optimal. To optimize adherence, it is recommended that implementation strategies focus on the workers level, organizational level, and the professional level.
KW - ADJUSTMENT DISORDERS
KW - ASSOCIATIONS
KW - CLINICAL-PRACTICE
KW - DEPRESSION
KW - Guideline adherence
KW - IMPACT
KW - Implementation
KW - MANAGEMENT
KW - Mental health
KW - Occupational health
KW - Occupational health professionals
KW - Occupational medicine
KW - PHYSICIANS
KW - Practice guideline
KW - QUALITY
KW - RETURN
KW - WORKERS
KW - Work disability prevention
U2 - 10.1186/s12913-019-4058-5
DO - 10.1186/s12913-019-4058-5
M3 - Article
SN - 1472-6963
VL - 19
JO - BMC Health Services Research
JF - BMC Health Services Research
M1 - 281
ER -