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The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence

Published online by Cambridge University Press:  11 April 2011

Domenico Semisa ,
Antonio Lasalvia ,
Maurizio Miceli ,
Rosa Bruna Dall'Agnola ,
Cristina Pucci ,
Sarah Bissoli ,
Enrico Visani ,
Carmine Pasquale Pismataro ,
Michele Vanetti  and
Rosaria Pioli
...Show all authors
Domenico Semisa*
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
Antonio Lasalvia
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Maurizio Miceli
Affiliation:
Dipartimento Salute Mentale, MOM-SMA 5 Azienda Sanitaria di Firenze
Rosa Bruna Dall'Agnola
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Cristina Pucci
Affiliation:
Dipartimento Salute Mentale, MOM-SMA 8, Azienda USL 10, Firenze
Sarah Bissoli
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Enrico Visani
Affiliation:
Dipartimento Salute Mentale Roma/A, Centro di Salute Mentale, Roma
Carmine Pasquale Pismataro
Affiliation:
Dipartimento Salute Mentale, Azienda Ospedaliera, S. Paolo Milano, Centro di Salute Mentale 1, Milano
Michele Vanetti
Affiliation:
Dipartimento Salute Mentale Nord ASL Novara, Novara
Rosaria Pioli
Affiliation:
IRCCS Fatebenefratelli Brescia
Mirella Ruggeri
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Antonio Lora
Affiliation:
Dipartimento Salute Mentale, Azienda Ospedaliera di Vimercate (Milano)
*
Address fo correspondence: Dr. D. Semisa, Dipartimento di Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti, Via Nicola Carnevale 7, 70021 Acquaviva delle Fonti (Bari). Fax: +39-080-3077082 E-mail: domenico.semisa@alice.it
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Summary

Aims – This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT's. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. Methods - In each of the 19 mental health departments or psychiatric services participating in the Project there were organized “multidisciplinary” focus groups and “specialistic” focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category. Results – Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable. Conclusions – In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators.

Declaration of Interest: None.

Keywords

clinical guidelinesfocus groupquality of carecommunity mental health servicesschizophrenia
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 291 - 304
Copyright
Copyright © Cambridge University Press 2008

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References

BIBLIOGRAFIA

Abell, P. C. (1990). Methodological achievements in sociology over the past few decades with special reference to the interplay of qualitative and quantitative methods. In What Has Sociology Achieved? (ed. Bryant, C. and Becker, H.). McMillan: London.Google Scholar
Bash, C. (1987). Focus group interview: an under-utilised research technique for improving theory and practice in health education. Health Education Quarterly 14, 411–418.CrossRefGoogle Scholar
Bloor, M., Frankland, J., Thomas, M. & Robson, K. (2002). I Focus Group nella Ricerca Sociale. Edizioni Erickson: Trento.Google Scholar
Bracco, R., Erlicher, A., Guidi, A., Rossi, E., Rossi, G., Semisa, D. & Zucco, E. (Eds.) (2003). Manuale di accreditamento professionale per il Dipartimento di Salute Mentale (edizione 2002). In Qualità e Salute Mentale, Rivista Sperimentale di Freniatria, Suppl. 1, 127, pp. 11–44.Google Scholar
Buizza, C., Bertocchi, E., Rossi, G. & Pioli, R. (2005). La percezione dello stigma dal punto di vista delle persone che soffrono di schizofrenia. Psichiatria di Comunità 4(1), 37–45.Google Scholar
Buizza, C., Schulze, B., Bertocchi, E., Rossi, G., Ghilardi, A. & Pioli, R. (2007). The stigma of schizophrenia from patients' and relatives' view: A pilot study in an Italian rehabilitation residential care unit. Clinical Practice and Epidemiology in Mental Health 3, 23. Retrieved August 4, 2008, from, http://www.cpementalhealth.com/content/3/1/23CrossRefGoogle Scholar
Chassan, J. B. (1967). Research Design in Clinical Psychology and Psychiatry. Appleton-Century-Crofts: New York.Google Scholar
Carrà, G., Barale, F. & Marinoni, A. (Eds.) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. Il Pensiero Scientifico Editore: Roma.Google Scholar
Cartabellotta, A. (1998). Evidence-based medicine. Il trasferimento dei risultati della ricerca alla pratica clinica. Recenti Progressi in Medicina 89, 140–150.Google Scholar
Cartabellotta, A. (2000). Medicina basata sulle evidenze o sulle linee guida? Ricerca e Sanità 2, 41–43.Google Scholar
Corrao, S. (2000). Il Focus Group. Franco Angeli: Milano.Google Scholar
Denning, J. D. & Verschelden, C. (1993). Using focus group in assessing training needs: empowering child welfare workers. Child Welfare 72, 569–579.Google Scholar
Erlicher, A. & Rossi, G. (a cura di) (2000). Manuale di Accreditamento Professionale per il Dipartimento di Salute Mentale. Centro Scientifico Editore: Torino.Google Scholar
Frankel, R. M. & Treger Hourigan, N. (2004). Thirty-five voices in search of an author: What focus groups reveal about patients' experiences in managed care settings. Communication & Medicine 1, 45–58.CrossRefGoogle ScholarPubMed
Gigantesco, A., Rossi, L., Morosini, P. & Flisi, E. (1995). QRS: un nuovo strumento di valutazione del supporto sociale. Bollettino di Psicologia.Google Scholar
Gigantesco, A., Picardi, A., Chiaia, E., Balbi, A. & Morosini, P. (2002). Patients' and relatives' satisfaction with psychiatric services in a large catchment area in Rome. European Psychiatry 17, 139–147.CrossRefGoogle Scholar
Gigantesco, A., Morosini, P. & Bazzoni, A. (2003a). Quality of psychiatric care: validation of an instrument for measuring inpatient opinion. International Journal for Quality in Health Care 15, 73–78.CrossRefGoogle ScholarPubMed
Gigantesco, A., Pioli, R., Vittorielli, M., Cascavilla, I., Bertocchi, E. & Morosini, P. (2003b). Valutazione breve, multidimensionale e mul-tiassiale dei pazienti dei servizi di salute mentale: il SAVE. Giornale Italiano di Psicopatologia 9, 251–254.Google Scholar
Gigantesco, A., Sbardella, A. & Morosini, P. (2003c). Confronto di due scale di risposta e studio dei determinanti della soddisfazione complessiva in un nuovo questionario autocompilato per la valutazione dell'opinione dei pazienti di un day hospital psichiatrico. Rivista di Psichiatria 38, 41–47.Google Scholar
Gigantesco, A., Picardi, A., Chiaia, E., Balbi, A. & Morosini, P. (2003d). Job satisfaction among mental health professionals in Rome, Italy. Community Mental Health Journal 39, 349–355.CrossRefGoogle ScholarPubMed
Gigantesco, A., Bertoldi, S., Mosna, S., Mirabella, F. & Morosini, P. (2004a). Gruppi di automutuoaiuto: la valutazione dei benefici dal punto di vista dei partecipanti. Rivista di Psichiatria 39, 410–416.Google Scholar
Gigantesco, A., Mirabella, F., Bonaviri, G. & Morosini, P. (2004b). Il benessere psicologico in popolazioni del settore sanitario. Giornale Italiano di Psicopatologia 10, 315–321.Google Scholar
Gigantesco, A., Camuffo, M., Mirabella, F. & Morosini, P. (2005). L'opinione dei genitori sui servizi di salute mentale dell'infanzia e dell'adolescenza: uno studio multicentrico. Annali Istituto Superiore di Sanità 41, 501–513.Google Scholar
Gigantesco, A., Picardi, A. de Girolamo, G. & Morosini, P. for the PROGRES Group (2007). Discriminant ability and criterion validity of the HoNOS in Italian psychiatric residential facilities. Psychopathology 40, 111–115.CrossRefGoogle ScholarPubMed
Gureje, O., Vàzquez-Barquero, J. L. & Janka, A. (1996). A comparison of alcohol and other drugs: experience from WHO collaborative cross-cultural applicability research (CAR) study. Addiction, 91, 1529–1538.Google ScholarPubMed
Knudsen, H. C., Vàzquez-Barquero, J. L., Welker, B., Gaite, L., Becker, T., Chrisholm, D., Ruggeri, M., Schene, A., Thornicroft, G. & the EPSILON STUDY Group (2000). Translation and cross-cultural adaptation of outcome measurements for schizophrenia. In Standardising European Outcome Measures for Schizophrenia Research. (ed. Becker, T., Knapp, M., Knudsen, H. C., Schene, A., Tansella, M., Thornicroft, G., Vazquez-Barquero, J. L. and the EPSILON Study Group), pp. s8–s14. British Journal of Psychiatry, Monograph Supplement 39.Google Scholar
Kreuger, R. A. (1994). Focus Groups. Sage: Thousand Oakes, CA.Google Scholar
Kritzinger, J. (1994). The methodology of focus group: the importance of interactions between research participants. Sociology of Health and Illness 16, 103–121.CrossRefGoogle Scholar
Lora, A, Corlito, G., Miceli, M., Di Munzio, W., Lasalvia, A., Tanini, A., Mari, L., Casacchia, M., Cristofalo, D., Magnani, N., Semisa, D. & Ruggeri, M., per il Gruppo, Siep-Direct's (2008a). The treatment of acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 319–330.CrossRefGoogle Scholar
Lora, A., Morganti, C., Erlicher, A., Burti, L., Buscaglia, G., Pegoraro, M., Iacchetti, D., Cristofalo, D., Ruggeri, M. & Semisa, D., per il Gruppo, Siep-Direct's (2008b). Management of violent behaviour and rapid tranquillisation during acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 349–357.CrossRefGoogle Scholar
Morgan, D. (1997). Focus Groups as Qualitative Research (Qualitative research methods, Vol. 16). Sage Publications: Thousand Oaks CA.CrossRefGoogle Scholar
Morosini, P., Gigantesco, A., Mazzarda, A. & Gibaldi, L. (2003). HoNOSRoma: una versione ampliata, personalizzabile e che facilita la compilazione ripetuta nel tempo dello strumento HoNOS. Epidemiologia e Psichiatria Sociale 12, 53–62.CrossRefGoogle ScholarPubMed
Murray, S., Tapson, J., Turnbull, L., McCallum, J. & Little, A. (1994). Listening to local voices: adapting rapid appraisal to assess health and social needs in general practice. British Medical Journal 308, 698–700.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2003). Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Gaskell: London.Google Scholar
National Institute for Clinical Excellence (2002). Guidance on the use of newer (atypical) antipdychotic drugs for the treatment of schizophrenia. In Technology Appraisal No. 43. National Institute for Clinical Excellence: London.Google Scholar
Paccaloni, M., Pozzan, T., Rimondini, M. & Zimmermann, C. (2006). Knowledge and informative needs of patients with the diagnosis of schizophrenia, explored with focus group methods. Epidemiologia e Psichiatria Sociale 15 (2), 128–137.CrossRefGoogle ScholarPubMed
Paccaloni, M., Rimondini, M., Pozzan, T. & Zimmermann, C. (2008). The communication of the diagnosis of schizophrenia. Focus group findings on psychiatrists’ point of view. Epidemiologia e Psichiatria Sociale 17 (1), 65–76.CrossRefGoogle ScholarPubMed
Pascazio, L., Morosini, P., Bembich, S., Nardone, I., Clarici, A., Barbina, L., Zuttion, R. & Gigantesco, A. (in press). Description and validation of a geriatric multidimentional graphical instrument for promoting longitudinal evaluation. Archives of Gerontology and Geriatrics.Google Scholar
Pinto, A., Gigantesco, A., Morosini, P. & La Pia, S. (2007). Development, reliability and validity of a self administered questionnaire on subjective opinion about Delusions, and Voices (DV-SA). Psychopathology 40, 312–320.CrossRefGoogle Scholar
Pope, C. & Mays, N. (1995). Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. British Medical Journal 311, 42–45.CrossRefGoogle ScholarPubMed
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium? Epidemiologia e Psichiatria Sociale 17(4), 270–277.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lora, A. & Semisa, D. on behalf of the SIEP-DIRECT's Group (2008a). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of the main findings and the practical implications for the future of community based mental health services Epidemiologia e Psichiatria Sociale 17(4), 358–367.CrossRefGoogle ScholarPubMed
Ruggeri, M., Bacigalupi, M., Casacchia, M., Miceli, M., Morganti, C., Scavo, V., Allevi, L., Lupoi, S., Cristofalo, D., Lasalvia, A., Lora, A. & Semisa, D., per il Gruppo, Siep-Direct's (2008b). Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEp-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 305–318.CrossRefGoogle Scholar
Semisa, D., Casacchia, M., Di Munzio, W., Neri, G., Buscaglia, G., Burti, L., Pucci, C., Corlito, G., Bacigalupi, M., Parravani, R., Roncone, R., Cristofalo, D., Lora, A. & Ruggeri, M., per il Gruppo, Siep-Direct's (2008a). Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 331–348.CrossRefGoogle Scholar
Semisa, D, Lora, A, Morosini, P & Ruggeri, M. (2008b). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence in the treatment of schizophrenia. The design, the indicators, and the methodology of the study (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 278–290.CrossRefGoogle Scholar
Starace, F., Viparelli, G., Nardini, G. & Cappiello, V. (2005). Valutazione di linee guida per il trattamento farmacologico della schizofrenia: studio regionale. Psichiatria di Comunità 4, 27–36.Google Scholar
Veltro, F., Morosini, P., Gigantesco, A., Casacchia, M., Roncone, R., Dell'Acqua, G., Chiaia, E., Balbi, A., De Stefani, R. & Cesari, G. (2007). A new self-report questionnaire called “ABC” to evaluate in a clinical practice the aid perceived from services by relatives, needs and family burden of severe mental illness. Clinical Practice and Epidemiology in Mental Health 3, 15. Retrieved August 14, 2008, from http://www.cpementalhealth.com/content/3/1/15CrossRefGoogle Scholar
Wykurz, G. & Kelly, D. (2002). Developing the role of patients as teachers: literature review. British Medical Journal 325, 818–821.CrossRefGoogle ScholarPubMed
Zammuner, V. L. (2003). I Focus Group. Il Mulino: Bologna.Google Scholar