Randomised controlled trial of tailored strategies to implement guidelinesfor the management of patients with depression in general practice

Background: Various methods are available for implementing change in the cl inical behaviour of general practitioners (GPs). Although passive dissemina tion of in formation is generally ineffective, other methods can be variabl y effective. Few studies have investigated the impact of tailored methods. Aim, To determine whether methods tailored to overcome obstacles to change using psychological theories are more effective than dissemination alone in the implementation of guidelines for depression among GPs, Design of study: Randomised controlled trial. Setting. Sixty general practi ces in England, 30 GPs in the control-group, 34 in the intervention group. Method: Practitioners identified patients presenting with depression before and after the implementation of guidelines (control group n = 192 in the f irst data collection, n = 181 in the second. intervention group n = 210 in the first data collection and n = 197 in the second). The main outcome meas ures were: record of adherence to guideline recommendations in clinical rec ords; pro portion of patients with Beck Depression inventory (BDI) score le ss than 11 at 16 weeks after diagnosis. Results: in comparison with the control group, in the group of GPs receivin g tailored implementation, there were increases in the proportions of patie nts assessed for suicide risk. in the intervention group, the proportion of patients with BDI scores of less than 11 at 16 weeks increased. Conclusion. Obstacles to implementation can be identified and strategies ta ilored to address them. The findings indicate a new approach for research t o understand and develop methods of implementation.