Implementing work-related Mental-health guidelines in general PRacticE (IMPRovE): findings of a parallel cluster randomised controlled trial.

Abstract

Background: Mental health conditions arising from work are a rapidly increasing burden for individuals, employers and society, and are challenging to diagnose and treat.

Objective: To assess the effectiveness of a multicomponent intervention on increasing general practitioners' (GPs') adherence to the 'Clinical guideline for the diagnosis and management of work-related mental-health conditions in general practice' (the Guideline) and improve patient work and health and work outcomes.

Methods: Pragmatic hybrid III parallel cluster randomised controlled trial involving Australian GPs and their patients. GP clinics were randomly assigned to receive the intervention (GP participation in an academic detailing session, enrolment into a virtual community of practice, and receipt of resources). Those assigned to the control group received no support related to the implementation of the Guideline. GP adherence to guideline recommendations was assessed at baseline and 9 months postbaseline, using virtual simulated patient scenarios (vignettes) describing a diverse range of patient circumstances. Patient work and health outcomes (using the 21-item Depression and Anxiety Stress Scale and 36-item short-form) were assessed using self-report surveys.

Findings: Thirty-eight intervention clusters (52 GPs) and 36 control clusters (46 GPs) contributed to the primary outcome data. Intervention clusters had significantly higher adherence scores than control clusters, by 0.98 points on a 0-9 scale (95% CI 0.38 to 1.58) with a Cohen's d of 0.67. Patients recruited from 30 intervention (n=99) and 17 control (n=55) clusters contributed to the secondary outcome data. No differences were detected for patients' work or health outcomes due to an underpowered sample.

Conclusions: GP adherence to the Guideline improved as a result of receiving the multicomponent intervention.

Implications: Purposively designed multicomponent implementation strategies to increase guideline-concordant care should be incorporated into guideline production activities and operationalised with guideline release to facilitate evidence-based care.

Trial registration number: ACTRN12620001163998, November 2020.