An Implementation Strategy to Improve the Guideline Adherence of Insurance Physicians: A Process Evaluation Alongside an Experiment in a Controlled Setting

Background: We developed an implementation strategy for the insurance medicine guidelines for depression, which we implemented via a post-graduate course for insurance physicians (IPs). In this study we evaluate the physicians' experiences of the implementation strategy by measuring the following aspects: recruitment and reach, dose delivered and dose received, satisfaction and expectations, and perceived barriers. Methods: Insurance physicians conducting client disability assessments for the Dutch Institute for Employee Benefits Schemes were invited to attend a post-graduate course in implementation of the guidelines for depression in which a controlled experiment was embedded. Data were collected from the participating insurance physicians using questionnaires applied directly after the intervention and at three-month follow-up. Results: Of the 797 insurance physicians invited, 42 participated. Reach was 4.7%. The response to the questionnaires was 100%. The participants appraised the implementation strategy with a total score of 7.7 out of 10, and 81% expected to see improvement in their assessments of clients with depression. Physicians were still satisfied with the implementation strategy after three months. Changes in work routines and the time needed to apply the guidelines were perceived as barriers to use of the implementation strategy. Conclusions: The reach of the newly developed implementation strategy for the guidelines for depression was poor: only 42 IPs out of 900 invited actually attended the post-graduate course. However, the results show that the implementation strategy worked well in a controlled setting for all participants. They were satisfied with the course and with the tools provided, both immediately after the training program and after three months.