Determinants of adherence to recommendations for depressed elderly patients in primary care: a multi-methods study.

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.

DESIGN AND SETTING

Group and individual interviews and a survey were conducted in Norway.

METHOD

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.

PARTICIPANTS

Physicians and nurses from primary and specialist care, psychologists, researchers, and patients.

MAIN OUTCOME MEASURES

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.

IMPLICATIONS

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.