Major depressive disorders in the general hospital: How to implement guidelines

Objective: An implementation study that evaluated the impact of previously adopted guidelines on the clinical practice of medical residents was conducted to improve the recognition and treatment of major depressive disorders (MDDs) in hospitalized patients with somatic diseases. Methods: Guidelines were implemented in two wards (ENT and oncology) using intranet diffusion, interactive sessions with medical residents, and support material. Discharge letters of 337 and 325 patients, before and after the intervention, respectively, were checked for statement of diagnosis or treatment of MDDs and, in a post hoe analysis, for any mention about psychiatric management. Results: No difference was found in the number of diagnosed or treated MDDs before and after the intervention. However, significantly more statements about psychological status (29/309 vs. 13/327) and its management (36/309 vs. 19/327) were observed after the intervention (P <.01). Conclusion: The intervention was not successful in improving the management of MDDs. However, a possible effect on general psychological aspects of medical diseases was observed. (c) 2006 Elsevier Inc. All rights reserved.