Guideline implementation strategies for specialist mental healthcare

Girlanda, Francesca; Fiedler, Ines; Ay, Esra; Barbui, Corrado; Kösters, Markus

doi:10.1097/yco.0b013e328361e7ae

Cited by 25 publications

(23 citation statements)

References 22 publications

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“…They showed trends towards improvement in process and patient outcomes following guideline implementation [28]. This supports the legitimacy of CPG development and implementation in LMICs as one of a number of possible tools to approach scale up of mental health care in these settings.…”

Section: Introductionmentioning

confidence: 68%

“…A recent systematic review concluded that there was sufficient evidence from high income countries to view CPGs in mental healthcare as an essential asset if appropriately developed and implemented [28]. They showed trends towards improvement in process and patient outcomes following guideline implementation [28].…”

Section: Introductionmentioning

confidence: 99%

“…This supports the legitimacy of CPG development and implementation in LMICs as one of a number of possible tools to approach scale up of mental health care in these settings. On-going difficulties in methodology to evaluate implementation techniques has however been identified as a significant barrier to optimising the potential value of evidence-based guidelines as tools for population level improvements in care [28]. …”

Section: Introductionmentioning

confidence: 99%

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Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Docherty

Shaw

Goulding

et al. 2017

Int J Ment Health Syst

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BackgroundThere is a significant treatment gap in provision of effective treatment for people with mental disorders globally. In some Low and Middle Income Countries (LMICs) this gap is 90% or more in terms of untreated cases. Clinical practice guidelines (CPGs) are one tool to improve health care provision. The aim of this review is to examine studies of the effectiveness of evidence-based CPG implementation across physical and mental health care, to inform mental healthcare provision in low and middle income countries (LMICs), and to identify transferable lessons from other non-communicable diseases to mental health.MethodsA systematic literature review employing narrative synthesis and utilising the tools developed by the Cochrane Effective Practice and Organisation of Care (EPOC) group was conducted. Experimental studies of CPG implementation relating to non-communicable diseases, including mental disorders, in LMICs were retrieved and synthesised.ResultsFew (six) studies were identified. Four cluster randomised controlled trials (RCTs) related to the introduction of CPGs for non-communicable diseases in physical health; one cluster-RCT included CPGs for both a non-communicable disease in physical health and mental health, and one uncontrolled before and after study described the introduction of a CPG for mental health. All of the included studies adopted multi-faceted CPG implementation strategies and used education as part of this strategy. Components of the multi-faceted strategies were sometimes poorly described. Results of the studies included generally show statistically significant improvement on some, but not all, outcomes.ConclusionEvidence for the effectiveness of interventions to improve uptake of, and compliance with, evidence-based CPGs in LMICs for mental disorders and for other non-communicable diseases is at present limited. The sparse literature does, however, suggest that multifaceted CPG implementation strategies that involve an educational component may be an effective way of improving guideline adherence and therefore of improving clinical outcomes. Further work is needed to examine cost-effectiveness of CPG implementation strategies in LMICs and to draw conclusions on the transferability of implementation experience in physical health care to mental health practice settings. Strategies to ensure that CPGs are developed with clear guidance for implementation, and with explicit, methods to evaluate them should be a priority for mental health researchers and for international agencies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-016-0115-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Docherty

Shaw

Goulding

et al. 2017

Int J Ment Health Syst

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“…Numerous authors have highlighted the increasing role of clinical practice guidelines in both physical and mental healthcare over the last two decades (e.g., Franx, ; Girlanda, Fiedler, Ay, Barbui, & Koesters, ; Grimshaw et al, ; Nathan, ; Parry, Cape, & Pilling, ; Pilling, ; Woolf, Grol, Hutchinson, Eccles, & Grimshaw, ). Parry et al () suggested that ‘health care professionals are living in the age of evidence‐based guidance’ (p. 337), highlighting a ‘remarkable proliferation of clinical practice guidelines’ (p. 337).…”

mentioning

confidence: 99%

They're NICE and Neat, but Are They Useful? A Grounded Theory of Clinical Psychologists' Beliefs About and Use of NICE Guidelines

Court

Cooke

Scrivener

2016

Clin Psychology and Psychoth

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Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilized grounded theory methodology to examine clinical psychologists' beliefs about and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognized. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilized in UK mental health services. The current need for services to demonstrate ‘NICE compliance’ may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Guidelines have many benefits, but the current pressure for services to be ‘NICE compliant’ may be having unintended negative as well as positive effects. Lack of implementation may be partly the result of active choice by clinicians concerned to use the full range of professional skills and to offer flexibility and choice to service users. The current context is creating a perverse incentive for clinicians to say one thing but do another. This is problematic for services and a potential threat to the profession of clinical psychology.

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“…What effects do guideline dissemination and implementation strategies have on process and patient outcomes, i.e., on clinician behaviour and treatment outcome at the patient level? A number of papers have investigated the effects of mental health guidelines being implemented, and the results suggest that: (a) if any effects on provider performance or patient outcome are mostly moderate and temporary; (b) studies with positive outcomes used complex multifaceted strategies or specific psychological methods to implement guidelines; (c) our current knowledge about how guidelines should be implemented is sparse and inconclusive in mental health care; (d) future studies should attempt to employ more rigorous designs; (e) research on guideline implementation strategies should take into account potential barriers to knowledge translation; and (f) randomised controlled trials, controlled clinical trials and before-and-after studies comparing guideline implementation strategies v. usual care have not shown consistent positive effects of guideline implementation on provider performance, but a more consistent small to modest positive effect on patient outcomes (Weinmann et al 2007;Girlanda et al 2013Girlanda et al , 2016. This latter finding suggests that guideline implementation strategies may have affected aspects of clinician behaviour that were not measured in controlled trials and that effects on patient outcome may have come about through mechanisms that have hitherto escaped the attention of researchers.…”

Section: Guidelines and Guideline Implementationmentioning

confidence: 99%

Policies, guideline implementation and practice change – how can the process be understood?

Becker

Kilian

Kösters

2016

Epidemiol Psychiatr Sci

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Politics and policy: It is important to understand why, in the translational continuum from pilot research and randomised controlled efficacy trials to roll-out programmes and routine effectiveness studies, some service innovations are taken up by health service purchasers and providers, while others are not. Why do some innovative interventions or models of care get to the stage of implementation, while others fail to be funded?

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Guideline implementation strategies for specialist mental healthcare

Cited by 25 publications

References 22 publications

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

They're NICE and Neat, but Are They Useful? A Grounded Theory of Clinical Psychologists' Beliefs About and Use of NICE Guidelines

Policies, guideline implementation and practice change – how can the process be understood?

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