The impact of a digital guideline version on schizophrenia guideline knowledge: results from a multicenter cluster-randomized controlled trial
Authors: Halms Theresa , Gaigl Gabriele , Lorenz Carolin , Güler Duygu , Khorikian-Ghazari Naiiri , Röh Astrid , Burschinski Angelika , Gaebel Wolfgang , Flick Marisa , Pielenz Charline , Salveridou-Hof Eva , Schneider-Axmann Thomas , Schneider Marco , Wagner Elias , Falkai Peter , Lucae Susanne , Rentrop Michael , Zwanzger Peter , Seemüller Florian , Landgrebe Michael , Ortner Marion , Schneeweiß Bertram , Brieger Peter , Ajayi Klemens , Schwarz Michael , Heres Stephan , Marstrander Nicolay , Becker Thomas , Jäger Markus , Putzhammer Albert , Frasch Karel , Steber Raimund , Leucht Stefan , Hasan Alkomiet 
Published: July 2024

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