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Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium?

Part of: Special Articles

Published online by Cambridge University Press:  11 April 2011

Mirella Ruggeri
Mirella Ruggeri*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona
*
Address fo correspondence: Professor M. Ruggeri, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Policlinico, G. B. Rossi, P. le L. A. Scuro 10, 37134 Verona. Fax: +39-045-8027498 E-mail: mirella.ruggeri@univr.it
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Summary

This paper discusses some key aspects of the debate on the difficulties of incorporating scientific evidence into the daily work of clinicians in mental health services (MHS). It highlights the topics of: the utility of guidelines in this field, the ethical principles that should guide their utilisation, their limitations, obstacles impeding the diffusion of guidelines in psychiatry, and strategies that can be useful for overcoming the barriers to guideline implementation. The SIEP-DIRECT's ((DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia) Project's potential role in fostering this advancement is discussed in detail. This Project developed a set of 103 indicators that operationalised the NICE clinical guidelines for schizophrenia recommendations and tested them in 19 MHS in Italy. A multi-step design was used to assess recommendation and indicator acceptability in the Italian context; provide an assessment of any current discrepancies between routine practice and guideline recommendations in the treatment of schizophrenia; and understand the reasons for any discrepancies that might emerge. This process, moreover, was instrumental in keeping the debate arising during conduction of this Project far from the excesses of hostility - and excesses of “bright-eyed enthusiasm” - that frequently influence discussion on topic. This Project therefore showed potential to serve in the search for a happy medium, that can facilitate the pursuit of a fundamental advancement in guideline implementation in mental health services.

Declaration of Interest: None.

Keywords

clinical guidelinesschizophreniaoutcome assessmentcommunity mental health services.
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 270 - 277
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

Baillie, N., Bent, N., Leng, G., Kendall, T. & Shackleton, B. (2008). NICE guidelines and the role of indicators. Epidemiologia e Psichiatria Sociale 17(4), 254–257.CrossRefGoogle ScholarPubMed
Bazos, D. A., Weeks, W. B., Fisher, E. S., DeBlois, H. A., Hamilton, E. & Young, M. J. (2001). The development of a survey instrument for community health improvement. Health Services Research 36, 773–792.Google ScholarPubMed
Bollini, P., Pampallona, S., Nieddu, S., Bianco, M., Tibaldi, G. & Munizza, C. (2008). Indicators conformante with guidelines of schizophrenia treatment in mental health services. Psychiatric Services 59, 782–791.CrossRefGoogle ScholarPubMed
Brand, C, Landgren, F., Hutchinson, A., Jones, C., MacGregor, L. & Campbell, D. (2005). Clinical practice guidelines: barriers to durability after effective early implementation. Internal Medicine Journal 35 (3), 162–169.CrossRefGoogle ScholarPubMed
Burns, T. (2008). Case management and assertive community treatment: what is the difference? Epidemiologia e Psichiatria Sociale 17, 99–105.CrossRefGoogle ScholarPubMed
Carrà, G., Barale, F. & Marinoni, A. (Eds.) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. II Pensiero Scientifico Editore: Roma.Google Scholar
Carrà, G., Segagni Lusignani, G., Sciarini, P., Barale, F., Marinoni, A. & Clerici, M. (2008). And how shall we deal with adaptation and implementation of NICE schizophrenia guidelines in Italy? Much more than just cutting a good figure. Epidemiologia e Psichiatria Sociale 17(4), 258–262.CrossRefGoogle Scholar
Chilvers, R., Harrison, G., Sipos, A. & Barley, M. (2002). Evidence into practice. Application of psychological models of change in evidence-based implementation. British Journal of Psychiatry 181, 99–101.Google ScholarPubMed
Dennehy, E. B., Suppes, T., Rush, A. J., Miller, A. L., Trivedi, M. H., Crismon, M. L., Carmody, T. J. & Kashner, T. M. (2005). Does provider adherence to a treatment guideline change clinical outcomes for patients with bipolar disorder? Results from the Texas Medication Algorithm Project. Psychological Medicine 35(12), 1695–1706.CrossRefGoogle ScholarPubMed
Drake, R. E., Goldman, H. H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T. & Torrey, W. C. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services 52 (2), 179–182. Comment on: Psychiatric Services 2001 52 (1), 45–50.CrossRefGoogle ScholarPubMed
Feldman, P. H., Nadash, P. & Gursen, M. (2001). Improving communication between researchers and policy makers in long-term care: or “researchers are from Mars; policy makers are from Venus”. Gerontologist 41, 312–321.CrossRefGoogle ScholarPubMed
Forsner, T., Wistedt, A., Brommels, M. & Forsell, Y. (2008). An approach to measure compliance to clinical guidelines in psychiatric care BMC Psychiatry 8, 64.CrossRefGoogle ScholarPubMed
Foy, J. M. & Earls, M. F. (2005). A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder. Pediatrics 115(1), 97–104.CrossRefGoogle ScholarPubMed
Gaebel, W., Weinmann, S., Sartorius, N., Rutz, W. & McIntyre, J. S. (2005). Schizophrenia practice guidelines: international survey and comparison. British Journal of Psychiatry 187, 248–255.CrossRefGoogle ScholarPubMed
Gorrell, J., Cornish, A., Tennant, C., Rosen, A., Nash, L., McKay, D. & Moss, B. (2004). Changes in early psychosis service provision: a file audit. Australian and New Zealand Journal of Psychiatry 38(9), 687–693.CrossRefGoogle ScholarPubMed
Grol, R. & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients' care. Lancet 362 (9391), 1225–1230.CrossRefGoogle ScholarPubMed
Grol, R., Charbonneau, A., Rosen, A. K., Ash, A. S., Owen, R. R., Kader, B. & Spiro, A. (2001). Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care 39, 8 Suppl. 2), II46–54.CrossRefGoogle ScholarPubMed
Hankin, C., Herz, L. R., Jo, V. P. M., Kazis, L., Miller, D. R. & Berlowitz, D. R. (2003). Measuring the quality of depression care in a large integrated health system. Medical Care 41(5), 669–680.Google Scholar
Hermann, R. C. & Palmer, R. H. (2002). Common ground: a framework for selecting core quality measures for mental health and substance abuse care. Psychiatric Services 53, 281–287.CrossRefGoogle Scholar
Holmes, D., Murray, S. J, Perron, A. & Rail, G. (2006). Deconstructing the evidence-based discourse in health sciences: truth, power and fascism. International Journal of Evidence Based Mental Health Care 4, 180–186.Google ScholarPubMed
Johnson, S. (2008). So what shall we do about assertive community treatment? Epidemiologia e Psichiatria Sociale 17(2), 110–114.CrossRefGoogle ScholarPubMed
Kramer, T. L., Daniels, A. S., Zieman, G. L., Williams, C. & Dewan, N. A. (2000). Psychiatric practice variations in the diagnosis and treatment of major depression. Psychiatric services 51(3), 336–340.CrossRefGoogle ScholarPubMed
Lasalvia, A. & Ruggeri, M. (2007). Assessing the outcome of community-based psychiatric care: building a feedback loop from ‘real world’ health services research into clinical practice. Acta Psychiatrica Scandinavica, Suppl. 437, 6–15.CrossRefGoogle ScholarPubMed
Lehman, A. (1998). The role of mental health service research in promoting effective treatment for adults with schizophrenia. Journal of Mental Health Policy and Economics 1, 199–204.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Leucht, S. (2007). Psychiatric treatment guidelines: doctors non-compliance or insufficient evidence? Acta Psychiatrica Scandinavica 115, 417–419.CrossRefGoogle ScholarPubMed
McGrew, J. H., Pescosolido, B. & Wright, E. (2003). Case managers' perspectives on critical ingredients of assertive community treatment and on its implementation. Psychiatric Services 54(3), 370–376.CrossRefGoogle ScholarPubMed
McHugo, G., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C., Howard, H., Goldman, H. & Lutz Finnerty, M. (2007). Fidelity outcomes in the National Implementing Evidence-Based Practices Project. Psychiatric Services 58, 1279–1284.CrossRefGoogle ScholarPubMed
McIntyre, J. S. (2002). Usefulness and limitations of treatment guidelines in psychiatry. World Psychiatry 1(3), 186–189.Google ScholarPubMed
Mele, A. & de Girolamo, G. (2008). Advantages and limitations of clinical guidelines: can we change clinicians' behaviour? Epidemiologia e Psichiatria Sociale 17(4), 263–266.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
Rogers, J. A., Vergare, M. J., Baron, R. C. & Salzer, MS (2007). Barriers to recovery and recommendations for change: the Pennsylvania Consensus Conference on psychiatry's role. Psychiatric Services 58(8), 1119–1123.CrossRefGoogle ScholarPubMed
Rowlands, P. (2004). The NICE schizophrenia guidelines: the challenge of implementation. Advances in Psychiatric Treatments 10, 403–412.CrossRefGoogle Scholar
Ruggeri, M., Lasalvia, A., Tansella, M., Bonetto, C., Abate, M., Thornicroft, G., Allevi, L. & Ognibene, P. (2004). Heterogeneity in multi-dimensional outcomes of schizophrenia: 3 year follow-up for treated prevalent cases. British Journal of Psychiatry 184, 48–57.CrossRefGoogle Scholar
Ruggeri, M. & Tansella, M. (2008). Case management or assertive community treatment: are they really alternative approaches? Epidemiologia e Psichiatria Sociale, 17 (2), 93–98.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lasalvia, A., Salvi, G., Cristofalo, D., Bonetto, C. & Tansella, M. (2007). Applications and usefulness of routine measurement of patients' satisfaction with community-based mental health care. Acta Psychiatrica Scandinavica, Suppl. 437, 53–65.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lora, A. & Semisa, D on behalf of the SIEP-DIRECT's Group (2008). 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), 358–368.CrossRefGoogle ScholarPubMed
Saarni, S. I. & Gylling, H. A. (2004). Evidence based medicine guidelines: a solution to rationing or politics disguised as science? Journal of Medical Ethics 30, 171–175.CrossRefGoogle ScholarPubMed
Saxena, S. (2008). Use of clinical and service indicators to decrease the treatment gap for mental disorders: a global perspective. Epidemiologia e Psichiatria Sociale 17(4), 267–269.CrossRefGoogle ScholarPubMed
Saxena, S., van Ommeren, M., Lora, A. & Saraceno, B. (2006). Monitoring of mental health systems and services: comparison of four existing indicator schemes. Social Psychiatry and Psychiatric Epidemiology 41, 488–497.CrossRefGoogle ScholarPubMed
Saxena, S., Lora, A., Ommeren, M. V, Barrett, T., Morris, J. & Saraceno, B. (2007). WHO's assessment instrument for mental health systems: collecting essential information for policy and service delivery. Psychiatric Service 58(6), 816–821.CrossRefGoogle ScholarPubMed
Semisa, D., Lora, A., Morosini, P. & Ruggeri, M. (2008). 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
Sin, J. & Scully, E. (2008). An evaluation of education and implementation of psychosocial interventions within one UK mental healthcare trust Journal of Psychiatric and Mental Health Nursing 15, 161–169.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Tansella, M. (2008). Better Mental Health Care. Cambridge University Press: London.CrossRefGoogle Scholar
Torrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Flynn, L., Rush, A. J., Clark, R. E. & Klatzker, D. (2001). Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services 52 (1), 45–50.CrossRefGoogle ScholarPubMed
Vonnegut, M. (2007). Is quality improvement improving quality? A view from the doctor's office New England Journal of Medicine 357, 2652–2653.CrossRefGoogle ScholarPubMed
Weinmann, S., Koesters, M. & Becker, T. (2007). Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatrica Scandinavica 115, 420–433.CrossRefGoogle ScholarPubMed
Weinmann, S., Hoerger, S., Erath, M., Kilian, R., Gaebel, W. & Becker, T. (2008). Implementation of a schizophrenia practice guideline: Clinical results. Journal of Clinical Psychiatry 69, 1299–1306.CrossRefGoogle ScholarPubMed