This systematic review synthesized the findings from studies that evaluated the effects of health care provider interventions to increase evidence-based treatment for depression. The review identified diverse interventions. There was some indication that interventions can improve individual outcomes but we did not identify types of interventions that were consistently associated with improvements across indicators of guideline adherence.
Provider Interventions to Increase Uptake of Evidence-Based Treatment for Depression
A Systematic Review
Download eBook for Free
| Format | File Size | Notes |
|---|---|---|
| PDF file | 2.1 MB | Use Adobe Acrobat Reader version 10 or higher for the best experience. |
Research Questions
- What are the effects of interventions to increase provider uptake of evidence-based treatments for depression on health care professional behavior compared to no-intervention, wait-list control, usual care, or other provider interventions?
- Do the effects vary by type of intervention?
- Do the effects vary by type of provider?
- Do the effects vary by setting?
- Are effects on providers associated with patient outcomes?
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.
Key Findings
Studies evaluated diverse provider interventions to promote uptake of clinical practice guidelines and guideline-concordant practices
- Twenty-two randomized controlled trials promoting uptake of clinical practice guidelines or 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 indication that more complex interventions may be associated with larger intervention effects and that interventions can improve individual outcomes such as medication prescribing.
- Due to the small number of studies reporting team interventions or interventions in specialty care, robust evidence that effects vary by provider group or setting could not be reported.
- Effects on patients' health were mixed across studies and outcomes, but interventions improved the number of patients responding to treatment.
- The low quality of evidence and lack of replication of specific intervention strategies across studies limit the conclusions that can be drawn from the current literature.
Table of Contents
Chapter One
Introduction
Chapter Two
Methods
Chapter Three
Results
Chapter Four
Discussion
Appendix A
Search Strategy
Appendix B
Excluded Publications
Appendix C
Evidence Table of Included Studies
Appendix D
Critical Appraisal Table
Appendix E
Sensitivity Analyses for High-Quality Studies
Research conducted by
This research is sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.
This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.