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Randomized Controlled Trial
. 2024 Jul 29;22(1):311.
doi: 10.1186/s12916-024-03533-6.

The impact of a digital guideline version on schizophrenia guideline knowledge: results from a multicenter cluster-randomized controlled trial

Theresa Halms #  1 , Gabriele Gaigl #  2 , Carolin Lorenz  3 , Duygu Güler  2 , Naiiri Khorikian-Ghazari  2 , Astrid Röh  2 , Angelika Burschinski  3 , Wolfgang Gaebel  4   5 , Marisa Flick  4   5 , Charline Pielenz  4   5 , Eva Salveridou-Hof  4   5 , Thomas Schneider-Axmann  6 , Marco Schneider  6 , Elias Wagner  2   7 , Peter Falkai  6   8 , Susanne Lucae  8 , Michael Rentrop  3   9 , Peter Zwanzger  6   9 , Florian Seemüller  10 , Michael Landgrebe  11 , Marion Ortner  12 , Bertram Schneeweiß  13 , Peter Brieger  14 , Klemens Ajayi  14 , Michael Schwarz  14 , Stephan Heres  15 , Nicolay Marstrander  15 , Thomas Becker  16   17 , Markus Jäger  16   18 , Albert Putzhammer  19 , Karel Frasch  16   20 , Raimund Steber  21 , Stefan Leucht #  3 , Alkomiet Hasan #  2   22
Affiliations
Randomized Controlled Trial

The impact of a digital guideline version on schizophrenia guideline knowledge: results from a multicenter cluster-randomized controlled trial

Theresa Halms et al. BMC Med. .

Abstract

Background: Clinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Barriers to guideline adherence are multifaceted, influenced by individual, contextual, and guideline-related factors. This study aims to investigate the effectiveness of a digital guideline version compared to print/PDF formats in enhancing guideline adherence.

Methods: A multicenter, cluster-randomized controlled trial was conducted in South Bavaria, Germany, involving psychologists and physicians. Participants were divided into two groups: implementation of the guideline using a digital online version via the MAGICapp platform and the other using the traditional print/PDF version. The study included a baseline assessment and a post-intervention assessment following a 6-month intervention phase. The primary outcome was guideline knowledge, which was assessed using a guideline knowledge questionnaire.

Results: The study included 217 participants at baseline and 120 at post-intervention. Both groups showed significant improvements in guideline knowledge; however, no notable difference was found between both study groups regarding guideline knowledge at either time points. At baseline, 43.6% in the control group (CG) and 52.5% of the interventional group (IG) met the criterion. There was no significant difference in the primary outcome between the two groups at either time point (T0: Chi2(1) = 1.65, p = 0.199, T1: Chi2(1) = 0.34, p = 0.561). At post-intervention, both groups improved, with 58.2% in the CG and 63.5% in the IG meeting this criterion.

Conclusions: While the study did not include a control group without any implementation strategy, the overall improvement in guideline knowledge following an implementation strategy, independent of the format, was confirmed. The digital guideline version, while not superior in enhancing knowledge, showed potential benefits in shared decision-making skills. However, familiarity with traditional formats and various barriers to digital application may have influenced these results. The study highlights the importance of tailored implementation strategies, especially for younger healthcare providers.

Trial registration: https://drks.de/search/de/trial/DRKS00028895.

Keywords: Cluster-randomized controlled trial; Guideline implementation; Health personnel; MAGICapp; Practice guideline.

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Conflict of interest statement

A.H. was a member of advisory boards and received paid speakership by Boehringer-Ingelheim, Lundbeck, Otsuka, Rovi, and Recordati. He received paid speakership by AbbVie and Advanz. He is editor of the AWMF German guidelines for schizophrenia. M.R. was a member of advisory board and received paid speakership by Rovi. K.F. has received travel grants for congress participation by Janssen; he is vice chairman of ackpa (Association of Chief Psychiatrists in German General Hospitals) and Executive Committee Member of the DGPPN (German Association for Psychiatry, Psychotherapy and Psychosomatics). P.F. is co-editor of the German (DGPPN) schizophrenia treatment guidelines, co-author of the WFSBP schizophrenia treatment guidelines; on advisory boards and speaker fees from Janssen, Lundbeck, Otsuka, Servier, and Richter. In the last three years. S.L.2 has received honoraria for advising/consulting and/or for lectures and/or for educational material from Angelini, Boehringer Ingelheim, Eisai, Ekademia, GedeonRichter, Janssen, Karuna, Kynexis, Lundbeck, Medichem, Medscape, Mitsubishi, Neurotorium, Otsuka, NovoNordisk, Recordati, Rovi, Teva. Over the past three years, S.H. has received lecture fees from Johnson & Johnson, Boehringer-Ingelheim, Recordati and Otsuka/Lundbeck, as well as fees for scientific advisory boards in clinical trials for TEVA, ROVI, Merck and Boehringer-Ingelheim. All other authors do not report any conflicts of interest related to the subject of this work.

Figures

Fig. 1
Fig. 1
CONSORT flow chart showing enrollment and participation in cluster-randomized trial
Fig. 2
Fig. 2
A Percentages of participants who reached the primary outcome at T0 and T1; B percentages of correctly answered questions among participants at T0 and T1
See this image and copyright information in PMC

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