Aakhus Eivind, Granlund Ingeborg, Odgaard-Jensen Jan, Oxman Andrew D, Flottorp Signe A
Research Centre for Old Age Psychiatry, Innlandet Hospital Trust, N-2312, Ottestad, Norway.
Norwegian Knowledge Centre for the Health Services, Box 7004, St Olavs plass, N-0130, Oslo, Norway.
Implement Sci. 2016 Mar 9;11:32. doi: 10.1186/s13012-016-0397-3.
Elderly patients with depression are underdiagnosed, undertreated and run a high risk of a chronic course. General practitioners adhere to clinical practice guidelines to a limited degree. In the international research project Tailored Implementation for Chronic Diseases, we tested the effectiveness of tailored interventions to improve care for patients with chronic diseases. In Norway, we examined this approach to improve adherence to six guideline recommendations for elderly patients with depression targeting healthcare professionals, patients and administrators.
We conducted a cluster randomised trial in 80 Norwegian municipalities. We identified determinants of practice for six recommendations and subsequently tailored interventions to address these determinants. The interventions targeted healthcare professionals, administrators and patients and consisted of outreach visits, a website presenting the recommendations and the underlying evidence, tools to manage depression in the elderly and other web-based resources, including a continuous medical education course for general practitioners. The primary outcome was mean adherence to the recommendations. Secondary outcomes were improvement in depression symptoms as measured by patients and general practitioners. We offered outreach visits to all general practitioners and practice staff in the intervention municipalities. We used electronic software that extracted eligible patients from the general practitioners' lists. We collected data by interviewing general practitioners or sending them a questionnaire about their practice for four patients on their list and by sending a questionnaire to the patients.
One hundred twenty-four of the 900 general practitioners (14 %) participated in the data collection, 51 in the intervention group and 73 in the control group. We interviewed 77 general practitioners, 47 general practitioners completed the questionnaire, and 134 patients responded to the questionnaire. Amongst the general practitioners who provided data, adherence to the recommendations was 1.6 percentage points higher in the intervention group than in the control group (95 % CI -6 to 9).
The effectiveness of our tailored intervention to implement recommendations for elderly patients with depression in primary care is uncertain, due to the low response rate in the data collection. However, it is unlikely that the effect was large. It remains uncertain how best to improve adherence to evidence-based recommendations and thereby improve the quality of care for these patients.
ClinicalTrials.gov: NCT01913236 .
老年抑郁症患者存在诊断不足、治疗不足且病程呈慢性化的高风险。全科医生对临床实践指南的遵循程度有限。在国际研究项目“慢性病的定制化实施”中，我们测试了定制化干预措施对改善慢性病患者护理的有效性。在挪威，我们研究了这种方法对提高针对医护人员、患者及管理人员的老年抑郁症患者六项指南建议的遵循情况。
我们在挪威的80个市镇进行了一项整群随机试验。我们确定了六项建议的实践决定因素，随后针对这些决定因素定制干预措施。干预措施针对医护人员、管理人员和患者，包括外展访问、一个展示建议及相关证据的网站、管理老年抑郁症的工具及其他网络资源，其中包括为全科医生提供的持续医学教育课程。主要结局是对建议的平均遵循率。次要结局是患者和全科医生所测量的抑郁症状改善情况。我们向干预市镇的所有全科医生及执业人员提供外展访问。我们使用电子软件从全科医生的名单中提取符合条件的患者。我们通过采访全科医生或向他们发送关于其名单上四名患者的实践情况的问卷，并向患者发送问卷来收集数据。
900名全科医生中有124名（14%）参与了数据收集，干预组51名，对照组73名。我们采访了77名全科医生，47名全科医生完成了问卷，134名患者回复了问卷。在提供数据的全科医生中，干预组对建议的遵循率比对照组高1.6个百分点（95%CI：-6至9）。
由于数据收集的低回复率，我们在初级保健中为老年抑郁症患者实施建议的定制化干预措施的有效性尚不确定。然而，其效果不太可能很大。如何最好地提高对循证建议的遵循率从而改善这些患者的护理质量仍不确定。
ClinicalTrials.gov：NCT01913236 。
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