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Which physician and practice characteristics are associated with adherence to evidence-based guidelines for depressive and anxiety disorders?

Mirrian Smolders, Miranda Laurant, Peter Verhaak, Marijn Prins, Harm van Marwijk, Brenda Penninx, Michel Wensing, Richard Grol
Medical Care 2010, 48 (3): 240-8

BACKGROUND: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence.

OBJECTIVE: To investigate how practice- and professional-related factors are associated with adherence to these guidelines.

DESIGN: Cross-sectional cohort study.

PARTICIPANTS: A total of 665 patients with a composite interview diagnostic instrument diagnosis of depressive or anxiety disorders, and 62 general practitioners from 21 practices participated.

MEASURES: Actual care data were derived from electronic medical record data. The measurement of guideline adherence was based on performance indicators derived from evidence-based guidelines. Practice-, professional-, and patient-related characteristics were measured with questionnaires. The characteristics associated with guideline adherence were assessed by multivariate multilevel regression analysis.

RESULTS: A number of practice and professional characteristics showed a significant univariate association with guideline adherence. The multivariate multilevel analyses revealed that, after controlling for patient characteristics, higher rates of guideline adherence were associated with stronger confidence in depression identification, less perceived time limitations, and less perceived barriers for guideline implementation. These professional-related determinants differed among the overall concept of guideline adherence and the various treatment options.

CONCLUSIONS: This study showed that rates of adherence to guidelines on depressive and anxiety disorders were not associated with practice characteristics, but to some extent with physician characteristics. Although most of the identified professional-related determinants are very difficult to change, our results give some directions for improving depression and anxiety care.


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