background Many regional mental health care providers (ggz-instellingen) have implemented clinical guidelines. However, data on the actual use of guidelines in routine clinical practice are lacking.
aim To examine the clinical and psychosocial correlates of adherence in outpatients with mood, anxiety and somatoform disorders in a routine clinical setting.
method We developed a generic set of process indicators and assessed adherence during up to three years of follow-up in a randomly selected sample of 300 outpatients who started treatment. Patients were treated with pharmacotherapy, psychotherapy or a combination of both. At baseline, a standardised diagnostic interview, the Brief Symptom Inventory (bsi), the Social Functioning 36 (sf-36) and demographic variables were assessed. Using multivariable regression analysis we also identified independent factors associated with guideline adherence.
results Most treatment elements in this routine clinical practice setting were delivered according to the guidelines. We observed significant lower scores in the combined treatment group on the indicators ‘correct treatment module’and ‘stepped care’. Patients receiving psychotherapy had the best results on the separate indicators, except for frequency. Only a minority of the patients was treated in complete accordance with the guidelines. We also found that patients with low scores on the vitality-subscale of the Short Form-36 (sf-36) were at the highest risk to have low guideline-concordant care.
conclusion Assessment of guideline adherence is feasible with our cross diagnostic set of process indicators. Understanding factors that affect treatment adherence may help to prevent non-adherence and increase the quality as well as cost-effectiveness of care.