Presentation M O14

M O14 (Oral Presentation):
Improving occupational physician’s adherence to a practice guideline on mental health problems using a tailored implementation strategy.

Presented by: Margot CW Joosen


Joosen MCW1, van Beurden KM1, Pransky G2, Terluin B3, van Weeghel J1,4,5, Brouwers EPM1, van der Klink JJL6

  1. Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care
  2. Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA
  3. VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, Amsterdam, The Netherlands.
  4. Phrenos Centre of Expertise, Utrecht, The Netherlands
  5. Parnassia Group, Dijk en Duin Mental Health Center, Castricum, The Netherlands
  6. University Medical Center Groningen, University of Groningen, Department of Health Sciences,Division of Community and Occupational Medicine, Groningen, The Netherlands.



Whereas practice guidelines are important tools to improve quality of care, implementation is challenging. In an occupational health care setting, compliance to guidelines can contribute to improved work participation of sick listed workers. To improve adherence to a Dutch guideline for the management of mental health problems, we evaluated the feasibility and impact of an implementation strategy targeting barriers perceived by occupational physicians (OPs) and find solutions to overcome these barriers.


During one year, 31 OPs received an 8-session training using a Plan-Do-Check-Act (PDCA) approach in peer-learning groups. OPs discussed barriers that hindered guideline use, worked to find solutions to overcome them and implement these solutions in their practice. Protocol compliance and OPs’ experiences were qualitatively and quantitatively assessed. Using a questionnaire, the impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training.


The implementation strategy was successfully carried out: iterative PDCA cycles were successfully conducted and solutions implemented. Ninety percent of the OPs agreed that the peer-learning groups and the meetings spread over one year were highly effective training elements. Significant improvements (p<.05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs perceived no barriers related to knowledge and self-efficacy. Almost half of the OPs still perceived time constraints after the training. Perceived adherence increased from 48.8% to 96.8% (p<.01).


The results imply that using a PDCA approach focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence and contributed to OPs’ knowledge, attitudes, and skills in using the guideline. It is expected that this implementation strategy is suitable for a wider range of guidelines and professionals, as it is a generic approach to overcome barriers that care professionals perceive in a specific situation. This work was supported by the Work Disability Prevention CIHR Strategic Training Program, through the Canadian Institutes of Health Research (CIHR) grant(s) FRN:53909

Schedule Details

Monday September 29
13:45 - 15:15 Afternoon Concurrent Sessions (M O13 - M O24 and Seminar 2)
Session: Healthcare providers’ interventions I
Room B