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

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

• Multiple factors might impede or facilitate general practitioners’ (GPs’) adherence to guidelines for the care of depressed elderly patients. Interviews and a survey were conducted to identify and prioritize such determinants of adherence.
• Factors related to dissemination of guidelines, GPs’ time constraints, and the lack of priority given to elderly patients with depression were the most frequently suggested barriers to adherence.
• Other determinants were individual healthcare professional factors (e.g. their knowledge and skills), patient factors (e.g. their beliefs and preferences), incentives, and the availability of necessary resources.