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Kisely S, Herrman H, Chamoli S, Hemachandra D, Lawn S, Bajurny L, Wright N, Mellsop G. Determining the future role of clinical practice guidelines: The experience of Australia and New Zealand. Aust N Z J Psychiatry 2024; 58:742-746. [PMID: 38761089 PMCID: PMC11370169 DOI: 10.1177/00048674241253475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
There has been recent discussion in Australia and New Zealand concerning the utility of Clinical Practice Guidelines (CPGs) and the role of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in their development. The College Board therefore established a Steering Group (SG) to oversee an exploration of options and produce recommendations about contemporary approaches to the development of high-quality evidence-based clinical practice guidance for psychiatry. This paper outlines the SG's conclusions and recommendations, as well as the underlying methods and reasoning. In particular, we discuss best practice and recent developments in the synthesis of research evidence. Account has been taken of the opportunities offered by digital technologies, the proliferation of clinical evidence and awareness of the gains to be made by increased inclusion of lived-experience perspectives. It is recommended that the broader concept of best practice resources (BPRs) as now emphasised in so many fields of service is the most appropriate starting point for the College's role in this area especially as the expertise of the College and its fellows lends itself to the development of a range of BPRs. In conclusion, contemporary guidance needs to be tailored to the requirements of the practitioners seeking it, to articulate the real-world needs and experiences of patients, and to be delivered in a contemporary format that is responsive to rapidly emerging evidence. The experience in Australia and New Zealand may have implications elsewhere for the development of CPGs and BPRs more broadly.
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Affiliation(s)
- S Kisely
- The Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
| | - H Herrman
- Orygen, Parkville, VIC, Australia
- The Centre for Youth Mental Health, the University of Melbourne, Melbourne, VIC, Australia
| | - S Chamoli
- Bi-national Faculty of Adult Psychiatry Committee, The Royal Australian & New Zealand College of Psychiatrists (RANZCP), Melbourne, VIC, Australia
| | - D Hemachandra
- Department of Psychiatry, Canberra Health Services, Canberra, ACT, Australia
| | - S Lawn
- Lived Experience Australia, Adelaide, SA, Australia
| | - L Bajurny
- Policy, Practice, and Research, The Royal Australian & New Zealand College of Psychiatrists (RANZCP), Melbourne, VIC, Australia
| | - N Wright
- Policy, Practice, and Research, The Royal Australian & New Zealand College of Psychiatrists (RANZCP), Melbourne, VIC, Australia
| | - G Mellsop
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
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Koenig E, Hoffmann U, Fegert JM, Keller F, Sicorello M, Spohrs J, Kraus L, Nickel S, Schmahl C, Abler B, In-Albon T, Koenig J, Ougrin D, Kaess M, Plener PL. Training approaches for the dissemination of clinical guidelines for NSSI: a quasi-experimental trial. Child Adolesc Psychiatry Ment Health 2024; 18:99. [PMID: 39127743 DOI: 10.1186/s13034-024-00789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is of high clinical relevance due to its high prevalence and negative long-term implications. In 2016, the German consensus-based clinical guidelines for diagnostic, assessment and treatment of NSSI in childhood and adolescence were published. However, research indicates that clinical guidelines are often poorly implemented in clinical practice. One crucial part of this process is the training of healthcare professionals to transfer knowledge and capacities to bring guideline recommendations into clinical practice. METHODS The effect of three different dissemination strategies (printed educational material, e-learning, and blended-learning) on the NSSI guidelines´ recommendations was examined among 671 physicians and psychotherapists via an online-survey. The quasi-experimental study included three measurement points (before the training, after the training, 3-month follow-up) and mixed effects models were used to test for changes in knowledge, competences and attitudes toward NSSI and treatment. Moreover, the transfer of gained competences to practical work and user satisfaction were reviewed. RESULTS With all three training formats, the intended changes of the outcome variables could be observed. Hereby, the printed educational material condition showed the lowest improvement in the scores for the 'negative attitudes toward NSSI and those who self-injure'. The training effect remained stable throughout the follow-up measurement. The highest application rate of acquired intervention techniques in clinical practice was reported for the blended-learning condition. For all three training strategies, user satisfaction was high and evaluation of training quality was positive, with printed educational material receiving the lowest and blended-learning the highest evaluations. CONCLUSIONS In summary, all three training formats were perceived to be of high quality and seem to be suited to cover the needs of a heterogeneous group of physicians and psychotherapists. The choice of training method could be driven by considering which training goals are desired to be achieved and by the benefit-cost ratio allowing for tailored training approaches.
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Affiliation(s)
- Elisa Koenig
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany.
- German Center of Mental Health (DZPG), Partner site Ulm, Germany.
| | - Ulrike Hoffmann
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- German Center of Mental Health (DZPG), Partner site Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- German Center of Mental Health (DZPG), Partner site Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- German Center of Mental Health (DZPG), Partner site Ulm, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Spohrs
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Laura Kraus
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Sandra Nickel
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center of Mental Health (DZPG), Partner site Mannheim, Germany
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis Ougrin
- Youth Resilience Unit, WHO Collaborating Centre for Mental Health Services Development, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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3
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Halms T, Gaigl G, Lorenz C, Güler D, Khorikian-Ghazari N, Röh A, Burschinski A, Gaebel W, Flick M, Pielenz C, Salveridou-Hof E, Schneider-Axmann T, Schneider M, Wagner E, Falkai P, Lucae S, Rentrop M, Zwanzger P, Seemüller F, Landgrebe M, Ortner M, Schneeweiß B, Brieger P, Ajayi K, Schwarz M, Heres S, Marstrander N, Becker T, Jäger M, Putzhammer A, Frasch K, Steber R, Leucht S, Hasan A. The impact of a digital guideline version on schizophrenia guideline knowledge: results from a multicenter cluster-randomized controlled trial. BMC Med 2024; 22:311. [PMID: 39075458 PMCID: PMC11287881 DOI: 10.1186/s12916-024-03533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Clinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Barriers to guideline adherence are multifaceted, influenced by individual, contextual, and guideline-related factors. This study aims to investigate the effectiveness of a digital guideline version compared to print/PDF formats in enhancing guideline adherence. METHODS A multicenter, cluster-randomized controlled trial was conducted in South Bavaria, Germany, involving psychologists and physicians. Participants were divided into two groups: implementation of the guideline using a digital online version via the MAGICapp platform and the other using the traditional print/PDF version. The study included a baseline assessment and a post-intervention assessment following a 6-month intervention phase. The primary outcome was guideline knowledge, which was assessed using a guideline knowledge questionnaire. RESULTS The study included 217 participants at baseline and 120 at post-intervention. Both groups showed significant improvements in guideline knowledge; however, no notable difference was found between both study groups regarding guideline knowledge at either time points. At baseline, 43.6% in the control group (CG) and 52.5% of the interventional group (IG) met the criterion. There was no significant difference in the primary outcome between the two groups at either time point (T0: Chi2(1) = 1.65, p = 0.199, T1: Chi2(1) = 0.34, p = 0.561). At post-intervention, both groups improved, with 58.2% in the CG and 63.5% in the IG meeting this criterion. CONCLUSIONS While the study did not include a control group without any implementation strategy, the overall improvement in guideline knowledge following an implementation strategy, independent of the format, was confirmed. The digital guideline version, while not superior in enhancing knowledge, showed potential benefits in shared decision-making skills. However, familiarity with traditional formats and various barriers to digital application may have influenced these results. The study highlights the importance of tailored implementation strategies, especially for younger healthcare providers. TRIAL REGISTRATION https://drks.de/search/de/trial/DRKS00028895.
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Affiliation(s)
- Theresa Halms
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany.
| | - Gabriele Gaigl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany
| | - Carolin Lorenz
- Department of Psychiatry and Psychotherapy, Technische Universität München, Medical Faculty, Klinikum rechts der Isar, Munich, Germany
| | - Duygu Güler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany
| | - Naiiri Khorikian-Ghazari
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany
| | - Astrid Röh
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, Technische Universität München, Medical Faculty, Klinikum rechts der Isar, Munich, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, EU131, Germany
| | - Marisa Flick
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, EU131, Germany
| | - Charline Pielenz
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, EU131, Germany
| | - Eva Salveridou-Hof
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, EU131, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Schneider
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany
- Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | | | - Michael Rentrop
- Department of Psychiatry and Psychotherapy, Technische Universität München, Medical Faculty, Klinikum rechts der Isar, Munich, Germany
- Kbo Inn-Salzach-Klinik Wasserburg, Wasserburg, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Kbo Inn-Salzach-Klinik Wasserburg, Wasserburg, Germany
| | - Florian Seemüller
- Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen und Peißenberg, Garmisch-Partenkirchen, Germany
| | | | - Marion Ortner
- Kbo-Lech-Mangfall-Klinik Landsberg am Lech, Landsberg am Lech, Germany
| | | | - Peter Brieger
- Kbo-Isar-Amper-Klinikum München-Ost, Munich, Germany
| | - Klemens Ajayi
- Kbo-Isar-Amper-Klinikum München-Ost, Munich, Germany
| | | | - Stephan Heres
- Kbo-Isar-Amper-Klinikum München-Nord, Munich, Germany
| | | | - Thomas Becker
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Markus Jäger
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
- BKH Kempten, Kempten, Germany
| | | | - Karel Frasch
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
- BKH Donauwörth, Donauwörth, Germany
| | | | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Medical Faculty, Klinikum rechts der Isar, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, BKH Augsburg, Geschwister-Schönert-Str. 1, Augsburg, 86156, Germany
- DZPG (German Center for Mental Health), partner site München/Augsburg, Munich/Augsburg, Germany
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Nakamura T, Furihata R, Hasegawa N, Kodaka F, Muraoka H, Ichihashi K, Ochi S, Numata S, Tsuboi T, Makinodan M, Iida H, Onitsuka T, Kashiwagi H, Takeshima M, Hashimoto N, Nagasawa T, Usami M, Yamagata H, Takaesu Y, Miura K, Matsumoto J, Ohi K, Yamada H, Hori H, Inada K, Watanabe K, Hashimoto R, Yasui-Furukori N. The effect of education regarding treatment guidelines for schizophrenia and major depressive disorders on psychiatrists' hypnotic medication prescribing behavior: a multicenter study. BMC Psychiatry 2024; 24:399. [PMID: 38807065 PMCID: PMC11135008 DOI: 10.1186/s12888-024-05816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/05/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine whether the "Effectiveness of Guideline for Dissemination and Education in psychiatric treatment (EGIUDE)" project affects the rate of prescriptions of hypnotic medication and the type of hypnotic medications prescribed among psychiatrists, for schizophrenia and major depressive disorder in Japan. METHODS The EGUIDE project is a nationwide prospective study of evidence-based clinical guidelines for schizophrenia and major depressive disorder in Japan. From 2016 to 2021, clinical and prescribing data from patients discharged from hospitals participating in the EGUIDE project were used to examine hypnotic medication prescriptions The prescribing rate of hypnotics and the prescribing rate of each type of hypnotic (benzodiazepine receptor agonist, nonbenzodiazepine receptor agonist, melatonin receptor agonist, and orexin receptor antagonist) were compared among patients who had been prescribed medication by psychiatrists participating in the EGUIDE project and patients who had been prescribed medication by nonparticipating psychiatrists. Multivariate logistic regression analysis was performed to examine the effect of the EGUIDE project on the prescription of hypnotic medications. RESULTS A total of 12,161 patients with schizophrenia and 6,167 patients with major depressive disorder were included. Psychiatrists participating in the EGUIDE project significantly reduced the rate of prescribing hypnotic medication and benzodiazepine receptor agonists for both schizophrenia (P < 0.001) and major depressive disorder (P < 0.001) patients. CONCLUSION This is the first study to investigate the educational effects of guidelines for the treatment of psychiatric disorders on psychiatrists in terms of prescribing hypnotic medications to patients. The EGUIDE project may play an important role in reducing hypnotic medication prescription rates, particularly with respect to benzodiazepine receptor agonists. The results suggest that the EGUIDE project may result in improved therapeutic behavior.
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Affiliation(s)
- Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Yoshida-Honmachi, Kyoto, 606-8501, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Fumitoshi Kodaka
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Department of Psychiatry, The Jikei University School of Medicine, 3-18-13 Nishi-Shinbashi, Minato, 105-8471, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitazato, Sagamihara, 252-0373, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, 113-8655, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, 791-0295, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, 3-8-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, 181-8611, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Fukuoka, 814-0180, Japan
| | - Toshiaki Onitsuka
- NHO Sakakibara National Hospital, 777 Sakakibara-cho, Tsu, 514-1292, Japan
| | - Hiroko Kashiwagi
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Department of Forensic Psychiatry, National Center Hospital, National Center of Psychiatry and Neurology, 4-1-1 Ogawahigashi, Kodaira, 187-8551, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Sapporo, 060-8638, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, 272-8516, Japan
| | - Hirotaka Yamagata
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Kokoro Hospital Machida, 2140 Kamioyamadamachi, Machida, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, 903-0215, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hisashi Yamada
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Department of Neuropsychiatry, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Fukuoka, 814-0180, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitazato, Sagamihara, 252-0373, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, 181-8611, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, 321-0293, Japan.
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Setkowski K, van Balkom AJLM, Hoogendoorn AW, Franx G, Veerbeek M, de Winter RFP, Gilissen R. Reducing suicides in mental healthcare: results from a 4-year follow-up implementation study in the Netherlands (SUPRANET). Front Psychiatry 2024; 15:1080235. [PMID: 38707617 PMCID: PMC11068092 DOI: 10.3389/fpsyt.2024.1080235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/09/2024] [Indexed: 05/07/2024] Open
Abstract
Objective In 2016, the SUicide PRevention Action NETwork (SUPRANET) was launched. The SUPRANET intervention aims at better implementing the suicide prevention guideline. An implementation study was developed to evaluate the impact of SUPRANET over time on three outcomes: 1) suicides, 2) registration of suicide attempts, and 3) professionals' knowledge and adherence to the guideline. Methods This study included 13 institutions, and used an uncontrolled longitudinal prospective design, collecting biannual data on a 2-level structure (institutional and team level). Suicides and suicide attempts were extracted from data systems. Professionals' knowledge and adherence were measured using a self-report questionnaire. A three-step interrupted time series analysis (ITSA) was performed for the first two outcomes. Step 1 assessed whether institutions executed the SUPRANET intervention as intended. Step 2 examined if institutions complied with the four guideline recommendations. Based on steps 1 and 2, institutions were classified as below or above average and after that, included as moderators in step 3 to examine the effect of SUPRANET over time compared to the baseline. The third outcome was analyzed with a longitudinal multilevel regression analysis, and tested for moderation. Results After institutions were labeled based on their efforts and investments made (below average vs above average), we found no statistically significant difference in suicides (standardized mortality ratio) between the two groups relative to the baseline. Institutions labeled as above average did register significantly more suicide attempts directly after the start of the intervention (78.8 per 100,000 patients, p<0.001, 95%CI=(51.3 per 100,000, 106.4 per 100,000)), and as the study progressed, they continued to report a significantly greater improvement in the number of registered attempts compared with institutions assigned as below average (8.7 per 100,000 patients per half year, p=0.004, 95%CI=(3.3 per 100,000, 14.1 per 100,000)). Professionals working at institutions that invested more in the SUPRANET activities adhered significantly better to the guideline over time (b=1.39, 95%CI=(0.12,2.65), p=0.032). Conclusion Institutions labeled as above average registered significantly more suicide attempts and also better adhered to the guideline compared with institutions that had performed less well. Although no convincing intervention effect on suicides was found within the study period, we do think that this network is potentially able to reduce suicides. Continuous investments and fully implementing as many guideline recommendations as possible are essential to achieve the biggest drop in suicides.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Anton J. L. M. van Balkom
- Amsterdam University Medical Center (UMC), location Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest (Mental Health Institution), Amsterdam, Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center (UMC), location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gerdien Franx
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | | | - Remco F. P. de Winter
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
- GGZ Rivierduinen (Mental Health Institution), Leiden, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
- The School for Mental Health and Neuroscience (MHeNs) Maastricht University, Maastricht, Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
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Pervez A, Bukhari MM, Chhapra R, Baig MI, Martins RS, Pirzada S, Rizvi NA, Aamdani SS, Ayub B, Rehman AA, Mustafa MA, Nadeem S, Asad N, Haider AH, Nadeem T. Adolopment of clinical practice guidelines and creation of referral pathways for psychiatric conditions in Pakistan. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100387. [PMID: 38486880 PMCID: PMC10938165 DOI: 10.1016/j.lansea.2024.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.
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Affiliation(s)
- Alina Pervez
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Nashia Ali Rizvi
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | | | - Bushra Ayub
- Learning Research Centre, Patel Hospital, Karachi, Pakistan
| | - Alina Abdul Rehman
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Mohsin Ali Mustafa
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Sarah Nadeem
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Tania Nadeem
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
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Brattmyr M, Lindberg MS, Lundqvist J, Öst LG, Solem S, Hjemdal O, Havnen A. Clinically representative therapy for Nordic adult outpatients with common mental health problems: A systematic review and meta-analysis. Scand J Psychol 2024; 65:311-320. [PMID: 37902112 DOI: 10.1111/sjop.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
There is a knowledge gap regarding clinically representative therapy given in routine settings, that is treatment as usual (TAU), for patients with common mental health problems (CMHP). This review and meta-analysis aimed to investigate what characterizes clinically representative therapy in Nordic routine clinics and meta-analyze the outcome of such treatment. Databases (PubMed, EMBASE, PsychINFO, and SveMed+) were searched for TAU, CMHP, and Nordic countries, together with backward and forward search in Scopus (7 November 2022). Studies were either randomized controlled trials (RCT) or open trials, using prospective study designs, examining heterogeneous outpatient groups in routine treatment. Within- and between-group effect sizes (ES), using random effects model, and moderator analyses were calculated. Eleven studies (n = 1,413), demonstrated a small to moderate within-group ES with high heterogeneity (g = 0.49, I2 = 90%). ESs in RCTs were significantly smaller than in open trials. TAU had a marginally smaller ES (g = -0.21; adjusted for publication bias g = -0.06) compared to a broad set of clinical interventions. Clinically representative therapy in the Nordic countries demonstrated a wide variety of characteristics and also a marginally lower ES compared to other interventions. The ESs were smaller than other meta-analyses examining evidence-based treatments in routine treatment.
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Affiliation(s)
- Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Mental Health Care Services, Trondheim Municipality, Trondheim, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
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Jorgensen A, Larsen EN, Sloth MMB, Kessing LV, Osler M. Prescription patterns in unipolar depression: A nationwide Danish register-based study of 113,175 individuals followed for 10 years. Acta Psychiatr Scand 2024; 149:88-97. [PMID: 37990476 DOI: 10.1111/acps.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Evidence-based use of antidepressant medications is of major clinical importance. We aimed to uncover precription patterns in a large cohort of patients with unipolar depression. MATERIAL AND METHODS Using Danish nationwide registers, we identified individuals with a first-time hospital diagnosis of unipolar depression between January 1st, 2001, and December 31st, 2016. Redemeed prescriptions of antidepressants from five years before to five years after diagnosis were retreived. Lithium and relevant antipsychotics were included. Data were analyzed with descriptive statistics including sunburst plots. Cox regressions were used to rank the risk of treatment failure according to antidepressant category and depression severity, as measured by hazard ratios of drug shift. RESULTS The full study population consisted of 113,175 individuals. Selective Serotonin Reuptake Inhibitors was the predominantly prescribed first-line group, both before (55.4%) and after (47.7%) diagnosis and across depression severities. Changes of treatment strategy were frequent; 60.8%, 33.7%, and 17.1% reached a second, third, and fourth treatment trial after the hospital diagnosis, respectively. More than half of patients continued their pre-diagnosis antidepressant after diagnosis. The risk of change of treatment strategy was generally lower in mild-moderate depression and higher in severe depression, with tricyclic antidepressants carrying the highest risk in the former and the lowest risks in the latter. Overall, prescribing were often not in accordance with guidelines. CONCLUSION These findings uncover a potential for improving the clinical care for patients with unipolar depression through optimization of the use of marketed antidepressants.
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Affiliation(s)
- Anders Jorgensen
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Emma Neble Larsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Merete Osler
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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Schladitz K, Weitzel EC, Löbner M, Soltmann B, Jessen F, Schmitt J, Pfennig A, Riedel-Heller SG, Gühne U. [How Successful is the Participation of People with Mental Illness and Family Members in the Development of Evidence- and Consensus-Based Clinical Practice Guidelines? Results of a Survey in Psychiatry]. PSYCHIATRISCHE PRAXIS 2023. [PMID: 38134904 DOI: 10.1055/a-2201-7987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE The study examines how successful the participation of people with mental illness and family members is currently in the development of psychiatric guidelines. METHODS Survey results of N=561 (Response 37%) guideline developers are analyzed. RESULTS Involvement of affected individuals succeeds more often than that of family members (61% vs. 55%). 68% felt that this participation was central to successful guideline development. 51% perceived discrepancies between empirical evidence and experience perspective. 33-36% perceived a lack of appreciation of experience expertise, 37% an insufficient representation and 46% an inequality in consensus building. 45% did not see barriers effectively removed. CONCLUSION There remain challenges in the participation of people with mental illness and family members. There is an increasing awareness that their participation is central.
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Affiliation(s)
- Katja Schladitz
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Medizinische Fakultät, Leipzig
| | - Elena Caroline Weitzel
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Medizinische Fakultät, Leipzig
| | - Margrit Löbner
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Medizinische Fakultät, Leipzig
| | - Bettina Soltmann
- Medizinische Fakultät Carl Gustav Carus, Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU Dresden
| | - Frank Jessen
- Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Köln
| | - Jochen Schmitt
- Medizinische Fakultät Carl Gustav Carus, Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), TU Dresden
| | - Andrea Pfennig
- Medizinische Fakultät Carl Gustav Carus, Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU Dresden
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Medizinische Fakultät, Leipzig
| | - Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Medizinische Fakultät, Leipzig
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10
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O'Brien J, Gregg L, Wittkowski A. A systematic review of clinical psychological guidance for perinatal mental health. BMC Psychiatry 2023; 23:790. [PMID: 37904101 PMCID: PMC10614401 DOI: 10.1186/s12888-023-05173-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input. METHOD Eight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined. RESULTS From the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion. CONCLUSION Perinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.
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Affiliation(s)
- Jayne O'Brien
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Lynsey Gregg
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
| | - Anja Wittkowski
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- The University of Manchester, Manchester Health Alliance Science Centre, Manchester, M13 9PL, UK.
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK.
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Hasegawa N, Yasuda Y, Yasui-Furukori N, Yamada H, Hori H, Ichihashi K, Takaesu Y, Iida H, Muraoka H, Kodaka F, Iga JI, Hashimoto N, Ogasawara K, Ohi K, Fukumoto K, Numata S, Tsuboi T, Usami M, Hishimoto A, Furihata R, Kishimoto T, Nakamura T, Katsumoto E, Ochi S, Nagasawa T, Atake K, Kubota C, Komatsu H, Yamagata H, Ide K, Takeshima M, Kido M, Kikuchi S, Okada T, Matsumoto J, Miura K, Shimazu T, Inada K, Watanabe K, Hashimoto R. Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study. Psychiatry Clin Neurosci 2023; 77:559-568. [PMID: 37684711 DOI: 10.1111/pcn.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 09/10/2023]
Abstract
AIM This study aims to examine the real-world effectiveness of education regarding clinical guidelines for psychiatric disorders using 'the Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)' project. METHODS The EGUIDE project is a nationwide prospective implementation study of two clinical practice guidelines, i.e., the Guideline for Pharmacological Therapy of Schizophrenia and the Treatment Guidelines for Major Depressive Disorders, in Japan. Between 2016 and 2019, 782 psychiatrists belonging to 176 hospitals with psychiatric wards participated in the project and attended lectures on clinical practice guidelines. The proportions of guideline-recommended treatments in 7405 patients with schizophrenia and 3794 patients with major depressive disorder at participating hospitals were compared between patients under the care of psychiatrists participating in the project and those not participating in the project. Clinical and prescribing data on the patients discharged from April to September each year from participating hospitals of the project were also analyzed. RESULTS The proportions of three quality indicators (antipsychotic monotherapy regardless of whether other psychotropics medication, antipsychotic monotherapy without other psychotropics and no prescription of anxiolytics or hypnotics) for schizophrenia were higher among participating psychiatrists than among nonparticipating psychiatrists. As similar results were obtained in major depressive disorder, the effectiveness of the project for the dissemination of guideline-recommended treatment has been replicated. CONCLUSION This strategy of providing education regarding the clinical guidelines for psychiatric disorders was effective in improving the treatment-related behavior of psychiatrists. The use of this education-based strategy might contribute to resolving the mental health treatment gap.
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Affiliation(s)
- Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hisashi Yamada
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Hyogo Medical University, Hyogo, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Department of Psychiatry, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Aichi, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, Iwate Medical University School of Medicine, Iwate, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | | | - Shinichiro Ochi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Kiyokazu Atake
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Nippon Telegraph and Telephone West Corporation Kyushu Health Administration Center, Fukuoka, Japan
| | - Chika Kubota
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Miyagi, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Kenta Ide
- Department of Hospital Pharmacy, Hospital of University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Kido Clinic, Toyama, Japan
| | - Saya Kikuchi
- Department of Psychiatry, Tohoku University Hospital, Miyagi, Japan
| | - Tsuyoshi Okada
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Department of Psychiatry, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Leach MJ. Development and validation of the global assessment of the evidence implementation environment [GENIE] tool. Complement Ther Clin Pract 2023; 52:101764. [PMID: 37137208 DOI: 10.1016/j.ctcp.2023.101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Overcoming the various barriers to evidence implementation is critical to delivering evidence-based health care. Identifying and managing these obstacles is somewhat challenging however, due to interprofessional and interjurisdictional variations in reported barriers. An efficient, systematic, comprehensive and innovative approach to isolating the barriers to evidence implementation is therefore needed. MATERIALS AND METHODS Using a mixed methods design, the study aimed to develop, refine and validate a tool to assess the evidence implementation environment for complementary medicine (CM) professions. The tool was developed using a five-stage process, and refined and validated using a two-round e-Delphi technique. RESULTS Informed by reviews examining the barriers and enablers to evidence implementation in CM, and shaped by the Behaviour Change Wheel Framework, a preliminary 33-item tool was created (i.e. the Global Assessment of the Evidence Implementation Environment [GENIE] tool). A two-round Delphi technique was used to refine the criteria, with a panel of 23 experts agreeing to the removal of two criteria, and the addition of two items. In the end, the Delphi panel reached consensus on 33 criteria, which were sorted into nine stakeholder groups. CONCLUSION This study has for the first time, created an innovative tool to assess the capacity and capability of CM professions to engage in evidence-based practice at an optimal level. By assessing the evidence implementation environment of CM professions, the GENIE tool is able to determine where resources, infrastructure and personnel should be directed in order to optimise the uptake of evidence-based practices within CM professions.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia.
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13
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Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractThis scoping review aimed to synthesise the published literature on guiding principles for managing co-occurring alcohol/other drug (AOD) and mental health conditions in AOD treatment settings. Systematic search of key electronic databases (January 1, 2010, to February 17, 2021) produced 4583 articles, and independent title/abstract and full text screening left 43 articles for inclusion. Fifteen guiding principles were identified, most commonly: build a strong therapeutic relationship (n = 24 articles), provide holistic care (n = 12), involve peer support (n = 7), ensure continuity of care (n = 6), support the professional development and competence of workers (n = 6), and provide trauma-informed care (n = 5). Remaining principles were identified in < 5 articles. Limited empirical literature examined the impact of guiding principles on patient- and treatment-related outcomes. This review provides the first comprehensive synthesis of the international literature to derive guiding principles for managing co-occurring AOD and mental health conditions in AOD treatment. Further empirical research is needed to determine the effectiveness of principles at improving outcomes.
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Are guidelines a useful tool for improving outcomes in neurology? Nat Rev Neurol 2022; 18:447-448. [PMID: 35761065 DOI: 10.1038/s41582-022-00687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pereira VC, Silva SN, Carvalho VKS, Zanghelini F, Barreto JOM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Policy Syst 2022; 20:13. [PMID: 35073897 PMCID: PMC8785489 DOI: 10.1186/s12961-022-00815-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination.
Methods
This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA).
Results
This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways—single intervention, educational meeting—single intervention, organizational culture, and audit and feedback—both strategies implemented in combination with others—were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.
Conclusion
This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.
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