Determinants of adherence to recommendations for depressed elderly patients in primary care: A multi-methods study

Abstract

Objective. It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression. Design and setting. Group and individual interviews and a survey were conducted in Norway. Method. Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants. Participants. Physicians and nurses from primary and specialist care, psychologists, researchers, and patients. Main outcome measures. Determinants of adherence to recommendations for depressed elderly patients in primary care. Results. A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners’ time constraints, the low prioritization of elderly patients with depression, and the patients’ or relatives’ wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions. Implications. The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.

Key Words::

• Depression
• determinants of practice
• elderly patients
• general practice
• Norway
• primary care
• tailored implementation

Funding

The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement n° 258837, from Innlandet Hospital Trust under grant agreement n° 150204, and is also supported by the Norwegian Knowledge Centre for the Health Services.

Ethical approval

This project was approved by the Norwegian South-Eastern Health Authority's Regional Ethical Committee, registration n° 2011/2512-1.

Acknowledgements

The authors would like to thank the participants in the various activities that led to these results, with special thanks to the patients who contributed in interviews. They would also like to thank staff and patients at the Innlandet Hospital Trust Old Age Psychiatric Department who contributed in preparing letters to participants. They would like to express their gratitude to the representatives and their organisztions comprising the reference group: Rut Prietz, Norwegian Directorate of Health; Sølvi Hagen, Mental Health; Hilde Fryberg Eilertsen, Norwegian Nurses Organization; Ola Marstein, Norwegian Psychiatric Association; Sigrid Askum, Norwegian Association for Local and Regional Authorities; Laila Pran, Norwegian Psychological Association; Knut Engedal, Ageing and Health – Norwegian Centre for Research, Education and Service Development; Hans Olav Tungesvik, Norwegian Retirees Association; Jørund Straand, Department of General Practice and Community Medicine – University of Oslo; Bettina Husebø, Norwegian Association of General Practitioners in the Norwegian Medical Association.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.