Provider Interventions to Increase Uptake of Evidence-Based Treatment for Depression

The objective of this systematic review was to synthesize the effectiveness of health care provider interventions that aim to increase the uptake of evidence-based treatment of depression in routine clinical practice. This report summarizes results of comprehensive searches in the quality improvement, implementation science, and behavior change literature. Studies evaluated diverse provider interventions such as sending out depression guidelines to providers, education and training such as academic detailing, and combinations of education with other components such as targeting implementation barriers. A detailed critical appraisal process assessed risk of bias and study quality. The body of evidence was graded using established evidence synthesis criteria. Twenty-two randomized controlled trials promoting uptake of clinical practice guidelines and guideline-concordant practices met inclusion criteria. Results were heterogeneous and analyses comparing interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies. There was some evidence that interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated that more complex interventions may be associated with more favorable outcomes. However, we did not identify types of interventions that were consistently associated with improvements across indicators of guideline adherence and across studies. Due to the small number of studies reporting team interventions or approaches tested in specialty care we did not identify robust evidence that effects vary by provider group or setting. Low quality of evidence and lack of replication of specific intervention strategies limited conclusions that can be drawn from the existing research.