Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care

M.C.W. Joosen*, K.M. van Beurden, D.S. Rebergen, M.A.J.M. Loo, B. Terluin, J. van Weeghel, J.J.L. van der Klink, E.P.M. Brouwers

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

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.
Original languageEnglish
Article number281
Number of pages14
JournalBMC Health Services Research
Volume19
DOIs
Publication statusPublished - 2019

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Occupational Health
Mental Health
Delivery of Health Care
Guideline Adherence
Medical Records
Physicians
Occupational Health Services
Health Personnel
Netherlands

Keywords

  • ADJUSTMENT DISORDERS
  • ASSOCIATIONS
  • CLINICAL-PRACTICE
  • DEPRESSION
  • Guideline adherence
  • IMPACT
  • Implementation
  • MANAGEMENT
  • Mental health
  • Occupational health
  • Occupational health professionals
  • Occupational medicine
  • PHYSICIANS
  • Practice guideline
  • QUALITY
  • RETURN
  • WORKERS
  • Work disability prevention

Cite this

@article{5933551fd1d64443965ba2ef6062af06,
title = "Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care",
abstract = "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.",
keywords = "ADJUSTMENT DISORDERS, ASSOCIATIONS, CLINICAL-PRACTICE, DEPRESSION, Guideline adherence, IMPACT, Implementation, MANAGEMENT, Mental health, Occupational health, Occupational health professionals, Occupational medicine, PHYSICIANS, Practice guideline, QUALITY, RETURN, WORKERS, Work disability prevention",
author = "M.C.W. Joosen and {van Beurden}, K.M. and D.S. Rebergen and M.A.J.M. Loo and B. Terluin and {van Weeghel}, J. and {van der Klink}, J.J.L. and E.P.M. Brouwers",
year = "2019",
doi = "10.1186/s12913-019-4058-5",
language = "English",
volume = "19",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BMC",

}

Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care. / Joosen, M.C.W.; van Beurden, K.M.; Rebergen, D.S.; Loo, M.A.J.M.; Terluin, B.; van Weeghel, J.; van der Klink, J.J.L.; Brouwers, E.P.M.

In: BMC Health Services Research, Vol. 19, 281, 2019.

Research output: Contribution to journalArticleScientificpeer-review

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.

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

VL - 19

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

M1 - 281

ER -