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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

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

Authors: Margot C. W. Joosen, Karlijn M. van Beurden, David S. Rebergen, Monique A. J. M. Loo, Berend Terluin, Jaap van Weeghel, Jac J. L. van der Klink, Evelien P. M. Brouwers

Published in: BMC Health Services Research | Issue 1/2019

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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.

Trial registration

ISRCTN86605310. Registered 30 June 2010.
Appendix
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Metadata
Title
Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care
Authors
Margot C. W. Joosen
Karlijn M. van Beurden
David S. Rebergen
Monique A. J. M. Loo
Berend Terluin
Jaap van Weeghel
Jac J. L. van der Klink
Evelien P. M. Brouwers
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4058-5

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