Implementation of treatment guidelines for specialist mental health care

Bighelli, Irene; Ostuzzi, Giovanni; Girlanda, Francesca; Cipriani, Andrea; Becker, Thomas; Koesters, Markus; Barbui, Corrado

doi:10.1002/14651858.cd009780.pub3

Cited by 41 publications

(50 citation statements)

References 50 publications

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“…Previous studies have suggested that there could be a huge gap between the development of guidelines based on research evidence and their uptake in clinical practice. 18 Although the pathway from evidence to guideline is highly developed, the pathway from guideline to clinical practices is much less developed and has been examined in few studies. [19][20][21] This situation suggests that a lack of awareness of and familiarity with guidelines, as well as lack of a supply system, might prevent the implementation of guidelines in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Improvement of psychiatrists’ clinical knowledge of the treatment guidelines for schizophrenia and major depressive disorders using the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ project: A nationwide dissemination, education, and evaluation study

Takaesu

Watanabe

Numata

et al. 2019

Psychiatry Clin Neurosci

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Aim Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs. Methods Four hundred thirteen out of 461 psychiatrists attended two 1‐day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants’ clinical knowledge of the treatment guidelines using self‐completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants’ demographics and their clinical knowledge scores. Results The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder. Conclusion Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants’ clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.

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Section: Discussionmentioning

confidence: 99%

Improvement of psychiatrists’ clinical knowledge of the treatment guidelines for schizophrenia and major depressive disorders using the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ project: A nationwide dissemination, education, and evaluation study

Takaesu

Watanabe

Numata

et al. 2019

Psychiatry Clin Neurosci

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“…Managers often ignore the stage of exploration and disregard this as unnecessary and too timeconsuming [5]. However, in this project the exploration stage was seen as essential in clarifying and communicating the strategy and to facilitate employees' motivation for developing and adopting changes.…”

Section: Discussionmentioning

confidence: 99%

“…lack of time), clinical uncertainty, negative staff attitudes, anxiety about changing practice, information overload as well as a lack of culture and leadership [1,4]. There continues to be uncertainty about clinically meaningful and sustainable effect of treatment guidelines on patient outcomes and how best to implement such guidelines for maximal benefit [5,6]. While the health and mental health literatures describe several potentially promising implementation strategies [7], the evidence of their effectiveness remains less evaluated [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

From clinical guidelines to clinical care – does employee involvement make a difference to implementation?

Kleve¹,

Skarstein²,

Elgen³

2019

Preprint

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Background: Implementation of new knowledge into routine care is a complex endeavour that requires innumerable variables. Involving employees in the change process, good planning and communication as well as a commitment to training has been highlighted as important factors for successful implementation. Acknowledging change as a process may also be helpful. The aim of this paper was to describe the initial phase of the implementation process in changing practices within a child and adolescent mental health service. Method:Prior to the five-year project, an external service evaluation was carried out. The employees expressed a need for a clear direction from management to guide their clinical practice. A vision and strategy for the service was developed. Employees participated in the process of developing clinical standards during the first phase of implementation. Results:Fixsen's four stage model and the PSDA circle were used to guide the implementation process. The employees developed a template for clinical standard based on national and international clinical guidelines. During the period, 17 clinical standards were established and 10 new evidence based methods were implemented. All service leads (13) and a group of senior clinicians (32) were invited to participate in an evaluation five years after the initial service evaluation. There was overall agreement that the mental health service was developing positively ensuring high quality services for children and adolescents. In addition, both groups agreed that the introduction of clinical standards was important in ensuring quality care. Conclusion:Involving employees in the implementation process seemed to be an important factor in successfully changing a mental health service.

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“…This is particularly relevant if we consider that culturally related manifestations often include mood episodes with psychotic features [ 65 – 67 ]. Furthermore, the most appropriate options for an effective implementation of mental health recommendations into clinical practice remain unclear [ 68 ], and this issue results particularly challenging for humanitarian, low-resources settings [ 69 , 70 ]. Therefore, although guidance on psychopharmacology can notably improve the effectiveness and timeliness of interventions in humanitarian settings, this tool alone cannot be considered as exhaustive.…”

Section: Discussionmentioning

confidence: 99%

Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance

Ostuzzi

Barbui

Hanlon

et al. 2017

BMC Med

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BackgroundPopulations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings.MethodsFollowing the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations.ResultsWhen first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions.ConclusionsAdapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0960-z) contains supplementary material, which is available to authorized users.

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Implementation of treatment guidelines for specialist mental health care

Cited by 41 publications

References 50 publications

From clinical guidelines to clinical care – does employee involvement make a difference to implementation?

Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance

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