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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

Published online by Cambridge University Press:  11 April 2011

Domenico Semisa ,
Antonio Lora ,
Pierluigi Morosini  and
Mirella Ruggeri
Domenico Semisa*
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
Antonio Lora
Affiliation:
Dipartimento Salute Mentale, Azienda Ospedaliera di Vimercate, Vimercate (Milano)
Pierluigi Morosini
Affiliation:
Istituto Superiore di Sanità, Roma; IRCCS Fatebenefratelli, Brescia
Mirella Ruggeri
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Verona
*
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 – The aims of the SIEP-DIRECT'S Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia) are: 1) To evaluate the appropriateness of the NICE guidelines for schizophrenia in Italian Departments of Mental Health; 2) to develop and to test a set of SIEP indicators, based on the NICE recommendations, useful to evaluate their real application in mental health services. Methods – Based on the NICE recommendations, 103 indicators have been developed, some of them qualitative and the rest quantitative. These indicators investigate five different areas: 14 indicators concern the common elements in all phases of mental health care; 11 the treatment of first episode; 24 the crisis treatment; 41 the recovery promotion; 13 the urgency, including management of violent behaviours and fast soothing. After a pilot study conducted in 2 community mental health services, the indicators were tested in 19 Italian Departments of Mental Health, to obtain a self-evaluation of the quality of care and to verify the application of NICE recommendations in the clinical routine of these Services. Data for the self-evaluation have been obtained from the DSM'ls psychiatric informative system and from the Direction of the local health authorities or of the DSM. Moreover, for some indicators, information has been gathered from the clinical records, and by means of questionnaires administered to a sample of patients and relatives. Finally, “multidisciplinary” (i.e. involving different types of professionals) or “specialized” (i.e. involving only psychiatrists) focus groups have assessed the degree of similarity between practice and recommendation for 33 indicators. Finally, the focus group methodology has been applied in all services with the aim to judge the appropriateness of each NICE recommendation in the context of the Italian Departments of Mental Health. Results and Conclusions – Most NICE recommendations have been considered useful and appropriated to measure quality of care in the context of the Italian services. The SIEP indicators have been easily used by the services participating in the DIRECT's Project. The self-evaluation process has provided several data of great relevance to improve the quality of care for schizophrenia and implement clinical guidelines in Italy.

Declaration of Interest: None.

Keywords

clinical guidelinesschizophreniaquality of care evaluationfocus groupcommunity mental health services
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 278 - 290
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

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, Supplementum n. 1, vol. 127, pp. 11–44.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
Casati, G., Panella, P., Di Stanislao, F., Vichi, M. C. & Morosini, P. (Eds.) (2005). Gestione per Processi Assistenziali e Percorsi Assistenziali. Retrieved July 21, 2008, from http://www.epicentro.iss.it/focus/ocse/Cap1-Percorsi.pdfGoogle Scholar
Erlicher, A. & Rossi, G. (Eds.) (2000). Manuale di Accreditamento Professionale per il Dipartimento di Salute Mentale. Centro Scientifico Editore: Torino.Google Scholar
Field, M. J. & Lohr, K. N. (eds.) (1990). Clinical Practice Guidelines: DIRECT'Sions for a New Program. National Academy Press: Washington DC.CrossRefGoogle Scholar
Grilli, R. & Taroni, F. (2004). Governo Clinico. Il Pensiero Scientifico Editore: Roma.Google Scholar
Grilli, R., Magrini, N., Penna, A., Mura, G. & Liberati, A. (2000). Practice guidelines by specialty societies: the need for a critical appraisal. Lancet 355, 103–106.CrossRefGoogle ScholarPubMed
Lora, A. (2006). Sistema informativo e governo clinico. Psichiatria di Comunità 5, 217–221.Google Scholar
Lora, A., Cosentino, U., Gandini, A. & Zocchetti, C. (2007). Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy) (in Italian). Epidemiologia e Psichiatria Sociale 16(4), 330–338.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 psychiatric 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
Ministero della Salute (2001). Il Sistema Informativo Nazionale per la Salute Mentale. Modello per la Rilevazione di Strutture, Personale, Attività e Prestazioni dei Dipartimenti di Salute Mentale. Testo approvato dalla Conferenza fra lo Stato, le Regioni e le Province Autonome, Seduta 11 ottobre 2001. Retrieved July 21, 2008, from http://www.nsis.ministerosalute.it/imgs/C_22_pagineAree_48_paragrafi_paragrafo_0_listaFile_itemName_2_fileAllegato.pdfGoogle Scholar
Morosini, P. (2004). Indicatori in valutazione e miglioramento della qualità professionale. Rapporti Istisan, 04/29. Retrieved July 21, 2008, from http://www.iss.it/binary/publ/publi/04-29%20REV.1127220808.pdfGoogle Scholar
Morosini, P., Casacchia, M. & Roncone, R. (2000). Qualità dei Servizi di Salute Mentale: Manuale-Questionario per la Formazione Organizzativa, l'Autovalutazione e l'Accreditamento Professionale tra Pari. II Pensiero Scientifico Editore: Roma.Google Scholar
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 (2002a). Clinical Guideline 1. Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. National Institute for Clinical Excellence: London.Google Scholar
National Institute for Clinical Excellence (2002b). Treating and managing Schizophrenia (Core Interventions). Understanding NICE Guidance - Information for People with Schizophrenia, Their Advocates and Carers, and the Public. National Institute for Clinical Excellence: London.Google Scholar
National Institute for Clinical Excellence (2002c). 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
Panella, M., Marchisio, S. & Di Stanislao, F. (2003). Reducing clinical variation. Do clinical pathways work? International Journal of Quality in Health Care 15, 509–521.CrossRefGoogle ScholarPubMed
Pilling, S. & Price, K. (2006). Developing and implementing clinical guidelines: lessons from the NICE Schizophrenia Guideline. Epidemiologia e Psichiatria Sociale 15(2), 109–116.CrossRefGoogle ScholarPubMed
Pioli, R., Rossi, G. & Morosini, P. (2003). Accreditamento Volontario tra Pari delle Strutture Residenziali Riabilitative in Salute Mentale. Centro Scientifico Editore: Torino.Google Scholar
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT'S Project 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 (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
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
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B. & Richardson, W. S. (1996). Evidence-based medicine: what it is and what it isn't. British Medical Journal 312, 712.CrossRefGoogle ScholarPubMed
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., Lasalvia, A., Miceli, M., Dall'Agnola, R. B., Pucci, C., Bissoli, S., Visani, E., Pismataro, P., Vanetti, M., Pioli, R., Ruggeri, M. & Lora, A. (2008b). The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 291–304.CrossRefGoogle ScholarPubMed
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
Tansella, M. (2004). Psichiatria bipolare, linee guida sui trattamenti, valutazione degli esiti. In Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica (ed. Carrà, G., Barale, F. e Marinoni, A.). Il Pensiero Scientifico Editore: Roma.Google Scholar
World Health Organization (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope. WHO: Geneva.Google Scholar
World Health Organization (2005). World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS), Version 2.2. WHO: Geneva.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, Supplementum n. 1, vol. 127, pp. 11–44.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
Casati, G., Panella, P., Di Stanislao, F., Vichi, M. C. & Morosini, P. (Eds.) (2005). Gestione per Processi Assistenziali e Percorsi Assistenziali. Retrieved July 21, 2008, from http://www.epicentro.iss.it/focus/ocse/Cap1-Percorsi.pdfGoogle Scholar
Erlicher, A. & Rossi, G. (Eds.) (2000). Manuale di Accreditamento Professionale per il Dipartimento di Salute Mentale. Centro Scientifico Editore: Torino.Google Scholar
Field, M. J. & Lohr, K. N. (eds.) (1990). Clinical Practice Guidelines: DIRECT'Sions for a New Program. National Academy Press: Washington DC.CrossRefGoogle Scholar
Grilli, R. & Taroni, F. (2004). Governo Clinico. Il Pensiero Scientifico Editore: Roma.Google Scholar
Grilli, R., Magrini, N., Penna, A., Mura, G. & Liberati, A. (2000). Practice guidelines by specialty societies: the need for a critical appraisal. Lancet 355, 103–106.CrossRefGoogle ScholarPubMed
Lora, A. (2006). Sistema informativo e governo clinico. Psichiatria di Comunità 5, 217–221.Google Scholar
Lora, A., Cosentino, U., Gandini, A. & Zocchetti, C. (2007). Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy) (in Italian). Epidemiologia e Psichiatria Sociale 16(4), 330–338.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 psychiatric 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
Ministero della Salute (2001). Il Sistema Informativo Nazionale per la Salute Mentale. Modello per la Rilevazione di Strutture, Personale, Attività e Prestazioni dei Dipartimenti di Salute Mentale. Testo approvato dalla Conferenza fra lo Stato, le Regioni e le Province Autonome, Seduta 11 ottobre 2001. Retrieved July 21, 2008, from http://www.nsis.ministerosalute.it/imgs/C_22_pagineAree_48_paragrafi_paragrafo_0_listaFile_itemName_2_fileAllegato.pdfGoogle Scholar
Morosini, P. (2004). Indicatori in valutazione e miglioramento della qualità professionale. Rapporti Istisan, 04/29. Retrieved July 21, 2008, from http://www.iss.it/binary/publ/publi/04-29%20REV.1127220808.pdfGoogle Scholar
Morosini, P., Casacchia, M. & Roncone, R. (2000). Qualità dei Servizi di Salute Mentale: Manuale-Questionario per la Formazione Organizzativa, l'Autovalutazione e l'Accreditamento Professionale tra Pari. II Pensiero Scientifico Editore: Roma.Google Scholar
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 (2002a). Clinical Guideline 1. Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. National Institute for Clinical Excellence: London.Google Scholar
National Institute for Clinical Excellence (2002b). Treating and managing Schizophrenia (Core Interventions). Understanding NICE Guidance - Information for People with Schizophrenia, Their Advocates and Carers, and the Public. National Institute for Clinical Excellence: London.Google Scholar
National Institute for Clinical Excellence (2002c). 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
Panella, M., Marchisio, S. & Di Stanislao, F. (2003). Reducing clinical variation. Do clinical pathways work? International Journal of Quality in Health Care 15, 509–521.CrossRefGoogle ScholarPubMed
Pilling, S. & Price, K. (2006). Developing and implementing clinical guidelines: lessons from the NICE Schizophrenia Guideline. Epidemiologia e Psichiatria Sociale 15(2), 109–116.CrossRefGoogle ScholarPubMed
Pioli, R., Rossi, G. & Morosini, P. (2003). Accreditamento Volontario tra Pari delle Strutture Residenziali Riabilitative in Salute Mentale. Centro Scientifico Editore: Torino.Google Scholar
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT'S Project 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 (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
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
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B. & Richardson, W. S. (1996). Evidence-based medicine: what it is and what it isn't. British Medical Journal 312, 712.CrossRefGoogle ScholarPubMed
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., Lasalvia, A., Miceli, M., Dall'Agnola, R. B., Pucci, C., Bissoli, S., Visani, E., Pismataro, P., Vanetti, M., Pioli, R., Ruggeri, M. & Lora, A. (2008b). The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 291–304.CrossRefGoogle ScholarPubMed
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
Tansella, M. (2004). Psichiatria bipolare, linee guida sui trattamenti, valutazione degli esiti. In Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica (ed. Carrà, G., Barale, F. e Marinoni, A.). Il Pensiero Scientifico Editore: Roma.Google Scholar
World Health Organization (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope. WHO: Geneva.Google Scholar
World Health Organization (2005). World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS), Version 2.2. WHO: Geneva.Google Scholar