Implementation of Psychiatric Guidelines and Evidence-Based Knowledge in the Primary Care Sector

Tables of included studies

SBU’s Conclusions

• An effective implementation strategy involves strengthening the primary care organisation with specially trained professionals, eg nurses (referred to as care managers in the studies) responsible for support and continual contact with patients suffering from depression; and combining this with other interventions, eg education of care teams and feedback of patient data to physicians. Physicians write more appropriate prescriptions for antidepressants, and patients’ symptoms decrease. The effects last for at least 6 months after the completed intervention. We could not determine if the effects last longer since too few studies include repeated measurements. The interventions are cost-effective.
• Brief education as the sole intervention to promote adherence with guidelines and evidence on depression does not affect the diagnostic or communicative skills of general practitioners (GPs) or the symptoms of patients. Hence, education alone is not a cost-effective intervention.
• Brief education as the sole intervention to promote adherence with guidelines and evidence on managing at-risk use of alcohol does not affect patients’ alcohol habits. The influence of education on physician practices could not be evaluated since the studies present conflicting results.
• Studies of sufficient quality are too few to determine the effects of other implementation strategies in primary care (eg academic detailing, feedback, reminders, and audits aimed at changing physician behaviour) to promote adherence with evidence and guidelines on depression, anxiety, at-risk use of alcohol, and long-term use of benzodiazepines.
• No studies investigated the effects of using economic incentives in primary care to promote evidence and guidelines on depression, anxiety, at-risk use of alcohol, and long-term use of benzodiazepines.
• The effects of implementation depend on the context and nature of the change process. Hence, studies and systematic reviews should be complemented with methodology that illuminates contextual factors and the implementation process.