Key Findings: Treatment of Disruptive Behavior Problems – What Works?
Second, by including only studies that measure provider behavior and outcomes, we were able to judge whether the intervention is having the intended effects on the target of the intervention i. Nonetheless, this restriction excluded a large number of existing research studies that do not report on provider behavior. Third, to be included, studies had to report on depression treatment. Effects on improving recognition, screening, or diagnosis of patients or on increasing referral behavior to specialty mental health care settings should be assessed in future systematic reviews. Lastly, the individual interventions and promoted depression practice guidelines varied across studies.
Our review included studies using prominent guidelines such as the Agency for Health Research and Quality AHRQ treatment guidelines for depression in primary care [ 74 ], in addition to studies using treatment guidelines for which we could not verify whether the guidelines were evidence-based. Many of the studies did not specify in detail how lengthy or how much of a time commitment the guidelines were for providers, which could have accounted for the provider change behaviors findings described within the individual included studies.
Some standardization across studies regarding which and how guidelines were utilized in practice appears needed.
Evidence-based Care | AIM Specialty Health
Such standardization could help account for confounding factors in research studies, but the field may also benefit from a single source of information on best treatment practices for depression. Fourteen years ago, Gilbody and colleagues [ 30 ] reviewed organizational and educational interventions targeted at primary care providers treating depressed patients. Authors concluded that effective strategies to improve depression management in this setting were multi-faceted e. Sikorski and colleagues [ 31 ] similarly concluded that provider training alone does not seem to improve depression care.
Our review shows that, despite new research, provider interventions focused primarily on guideline distribution or education only are unlikely to be effective in the absence of additional components. Our review did not identify subgroups or categories of interventions that were consistently associated with increased adherence to depression guidelines or guideline-concordant practices.
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These findings underscore the need for further research to better understand how to effectively change provider behavior in differential care settings without organizational redesigns. Innovations are needed to support healthcare organizations that want to improve guideline adherence but do not intend to invest in efforts to restructure how care is delivered.
Research on provider interventions should be supported by a framework that allows for a more structured assessment to identify successful intervention approaches and the effects of individual intervention components. Center for Behavioral Health Statistics and Quality.
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The Canadian Journal of Psychiatry. Download references. We are grateful to the Cochrane Effective Practice and Organisation of Care group and Jeremy Grimshaw for input and resources that shaped the scope of this review. We also thank John Williams and Thomas Concannon for their helpful comments and Patty Smith for administrative assistance. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Department of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
All authors have given final approval of this final version to be published. EP and SH are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Correspondence to Eric R. LR is on the editorial board of Implementation Science. All authors declare no other financial or non-financial competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix A: Search strategy. Appendix C: Detailed quality of evidence and summary of findings. DOCX kb. Reprints and Permissions. Search all BMC articles Search. Systematic review Open Access Open Peer Review Published: 20 July Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression Eric R.
Abstract Background Depression is a common mental health disorder for which clinical practice guidelines have been developed. Methods We searched five databases through August using a comprehensive search strategy to identify English-language randomized controlled trials RCTs in the quality improvement, implementation science, and behavior change literature that evaluated outpatient provider interventions, in the absence of practice redesign efforts, to increase adherence to treatment guidelines or guideline-concordant practices for depression.
Results Twenty-two RCTs promoting adherence to clinical practice guidelines or guideline-concordant practices met inclusion criteria. Conclusions Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines. Open Peer Review reports. Eligibility Eligible participants were healthcare providers responsible for patient care in the outpatient setting e. Update Location. If you want NextDay, we can save the other items for later. Yes—Save my other items for later. No—I want to keep shopping.
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