Efficacy of an active implementation process of a computerized CPG of major depression disorder in primary care

Abstract

Introduction

The application of scientific evidence in clinical practice management of Major Depressive Disorder (MDD) is complex. Generally, the usual dissemination process and implementation of Clinical Practice Guidelines (CPG) induce modest changes. A computerized version of a Clinical Practice Guideline for Major Depression (e-CPG-MD) has been integrated in Electronic Clinical Records of Primary Care in Catalonia (Spain). It offers an opportunity to improve clinical results. The design allows access to precise help in the visit itself, improving diagnosis, treatment and follow-up.

Objectives

To evaluate the effects of a multifaceted implementation process of e-CPG-MD, analysing their use and changes in MDD diagnosis.

Methods

A cluster randomized clinical trial was performed in 10 primary care centers (PCC) in Barcelona. In five of ten centers, a multifaceted implementation process of the e-CPG-MD was developed during 6 month. The active process includes: interactive training program, regular feedback audit, educational outreach visits and periodic reminders.

Results

The multifaceted implementation of e-CPG-MD was associated with a significant increase in use during the first 6 months (4.1% + 3.1% vs. 52.7% + 7.3%, P < 0.001). In the active centers, the MD diagnosis increased significantly (rate quotient = 1.56, P < 0.001) and the proportion of moderate and severe MD increased (13.6% vs 41.1%, P = 0.002).

Conclusions

A multifaceted implementation method of e-CPG-MD increased significantly its use in active centers at 6 months. Diagnosis of MDD and the proportion of moderate and severe cases also increased significantly.

Disclosure of interest

The authors have not supplied their declaration of competing interest.