Effectiveness of a multifaceted implementation strategy on physicians’ referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial

BMC Family Practice

Research Article

Steven Teerenstra¹  Marcel GM Olde Rikkert²  Maria WG Nijhuis-van der Sanden³  Myrra JFJ Vernooij-Dassen⁴  Maud JL Graff⁵  Carola ME Döpp⁶ 

[1] Department for Health Evidence (Biostatistics section), Nijmegen, The Netherlands;Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands;Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands;Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Kalorama Foundation, Beek-Ubbergen, The Netherlands;Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands;Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands;Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 114 IQ Healthcare, 6500 HB, Nijmegen, The Netherlands;

关键词: Dementia;    Occupational Therapist;    Implementation Strategy;    Psychosocial Intervention;    Occupational Therapy;   

DOI  :  10.1186/1471-2296-14-70

 received in 2012-12-28, accepted in 2013-04-16,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundTo evaluate the effectiveness of a multifaceted implementation strategy on physicians’ referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program).MethodsA cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therapists received a postgraduate course. In the experimental group physicians and managers had access to a website, received newsletters, and were approached by telephone. In addition, physicians were offered one outreach visit. In the experimental group occupational therapists received the postgraduate course, training days, outreach visits, regional meetings, and access to a reporting system. Main outcome measure was the number of COTiD referrals received by each cluster which was assessed at 6 and 12 months after the start of the intervention. Referrals were included from both participating physicians (enrolled in the study and received either the control or experimental intervention) and non-participating physicians (not enrolled but of whom referrals were received by participating occupational therapists). Mixed model analyses were used to analyze the data. All analyses were based on the principle of intention-to-treat.ResultsAt 12 months experimental clusters received significantly more referrals with an average of 5,24 referrals (SD 5,75) to the COTiD program compared to 2,07 referrals in the control group (SD 5,14). The effect size at 12 months was 0.58. Although no difference in referral rate was found for the physicians participating in the study, the number of referrals from non-participating physicians (t −2,55 / 43 / 0,02) differed significantly at 12 months.ConclusionPassive dissemination strategies are less likely to result in changes in professional behavior. The amount of physicians exposed to active strategies was limited. In spite of this we found a significant difference in the number of referrals which was accounted for by more referrals of non-participating physicians in the experimental clusters. We hypothesize that the increase in referrals was caused by an increase in occupational therapists’ efforts to promote their services within their network.Trial registrationNCT01117285

【 授权许可】

CC BY   
© Döpp et al.; licensee BioMed Central Ltd. 2013