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Research Questions

  1. 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?
  2. Do the effects vary by type of intervention?
  3. Do the effects vary by type of provider?
  4. Do the effects vary by setting?
  5. 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

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.

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