Impact of the ICD-10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care

Croudace, T., Evans, J., Harrison, G., Sharp, D.J., Wilkinson, E., McCann, G., Spence, M., Crilly, C. and Brindle, L. (2003) Impact of the ICD-10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care. British Journal of Psychiatry, 182 (1), 20-30.

Abstract

Background The World Health Organization (WHO) ICD-10 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (1996) have not been evaluated in a pragmatic randomised controlled trial (RCT).
Aims: To evaluate the effect of local adaptation and dissemination of the guidelines.
Method: Pragmatic, pair-matched, cluster RCT involving 30 practices.
Results: Guideline practices were less sensitive but more specific in identifying morbidity, but these differences were not significant. Guideline patients did not differ from usual-care patients on 12-item General Health Questionnaire scores at 3-month follow-up or in the proportion who were still cases. There were no significant differences in secondary outcomes.
Conclusions: Attempts to influence clinician behaviour through a process of adaptation and extension of guidelines are unlikely to change detection rates or outcomes.

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