Aakhus Eivind, Granlund Ingeborg, Oxman Andrew D, Flottorp Signe A
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, 2312 Ottestad, Norway ; Norwegian Knowledge Centre for the Health Services, Box 7004 St Olavs plass, 0130 Oslo, Norway.
Norwegian Knowledge Centre for the Health Services, Box 7004 St Olavs plass, 0130 Oslo, Norway.
Int J Ment Health Syst. 2015 Sep 12;9:36. doi: 10.1186/s13033-015-0027-5. eCollection 2015.
To improve adherence to evidence-based recommendations, it is logical to identify determinants of practice and tailor interventions to address these. We have previously prioritised six recommendations to improve treatment of elderly patients with depression, and identified determinants of adherence to these recommendations. The aim of this article is to describe how we tailored interventions to address the determinants for the implementation of the recommendations.
We drafted an intervention plan, based on the determinants we had identified in a previous study. We conducted six group interviews with representatives of health professionals (GPs and nurses), implementation researchers, quality improvement officers, professional and voluntary organisations and relatives of elderly patients with depression. We informed about the gap between evidence and practice for elderly patients with depression and presented the prioritised determinants that applied to each recommendation. Participants brainstormed individually and then in groups, suggesting interventions to address the determinants. We then presented evidence on the effectiveness of strategies for implementing depression guidelines. We asked the groups to prioritise the suggested interventions considering the perceived impact of determinants and of interventions, the research evidence underlying the interventions, feasibility and cost. We audiotaped and transcribed the interviews and applied a five step framework for our analysis. We created a logic model with links between the determinants, the interventions, and the targeted improvements in adherence.
Six groups with 29 individuals provided 379 suggestions for interventions. Most suggestions could be fit within the drafted plan, but the groups provided important amendments or additions. We sorted the interventions into six categories: resources for municipalities to develop a collaborative care plan, resources for health professionals, resources for patients and their relatives, outreach visits, educational and web-based tools. Some interventions addressed one determinant, while other interventions addressed several determinants.
It was feasible and helpful to use group interviews and combine open and structured approaches to identify interventions that addressed prioritised determinants to adherence to the recommendations. This approach generated a large number of suggested interventions. We had to prioritise to tailor the interventions strategies.
为提高对循证建议的依从性，确定实践的决定因素并针对性地制定干预措施是合理的。我们之前已对改善老年抑郁症患者治疗的六项建议进行了优先排序，并确定了对这些建议依从性的决定因素。本文旨在描述我们如何针对性地制定干预措施以解决这些决定因素，从而实施这些建议。
我们根据之前研究中确定的决定因素起草了一份干预计划。我们与健康专业人员（全科医生和护士）、实施研究人员、质量改进官员、专业和志愿组织以及老年抑郁症患者的亲属代表进行了六次小组访谈。我们告知了老年抑郁症患者证据与实践之间的差距，并介绍了适用于每项建议的优先决定因素。参与者先单独进行头脑风暴，然后分组进行，提出解决这些决定因素的干预措施。然后，我们展示了实施抑郁症指南策略有效性的证据。我们要求各小组根据决定因素和干预措施的感知影响、干预措施背后的研究证据、可行性和成本，对建议的干预措施进行优先排序。我们对访谈进行了录音和转录，并应用了一个五步框架进行分析。我们创建了一个逻辑模型，将决定因素、干预措施和预期的依从性改善联系起来。
六个小组共29人提出了379条干预建议。大多数建议可以纳入起草的计划，但各小组提出了重要的修改或补充。我们将干预措施分为六类：市政当局制定协作护理计划的资源、健康专业人员的资源、患者及其亲属的资源、外展探访、教育和基于网络的工具。一些干预措施解决一个决定因素，而其他干预措施解决几个决定因素。
通过小组访谈并结合开放式和结构化方法来确定解决对建议依从性的优先决定因素的干预措施是可行且有帮助的。这种方法产生了大量建议的干预措施。我们必须进行优先排序以调整干预策略。
