Indicators of Conformance With Guidelines of Schizophrenia Treatment in Mental Health Services

• Published in: Psychiatric services (Washington, D.C.) Vol. 59; no. 7; pp. 782 - 791
• Main Authors: Bollini, Paola, Pampallona, Sandro, Nieddu, Salvatore, Bianco, Maurizio, Tibaldi, Giuseppe, Munizza, Carmine
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Association 01.07.2008; American Psychiatric Publishing, Inc
• Subjects: Archives & records; Biological and medical sciences; Clinical medicine; Clinical trials; Data collection; Female; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Guidelines as Topic - standards; Health care policy; Heart attacks; Humans; Inpatient care; Italy; Male; Medical sciences; Mental health; Mental Health Services - standards; Mental Health Services - utilization; Outcome Assessment (Health Care) - standards; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Prevention. Health policy. Planification; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotic Disorders - economics; Psychotic Disorders - therapy; Psychotropic drugs; Quality of Life; Research methodology; Schizophrenia - economics; Schizophrenia - therapy; Social psychiatry. Ethnopsychiatry; Studies; Support groups; Vocational rehabilitation; Italy; Europe; Social environment; Human; Schizoaffective psychosis; Compliance; Mental health; Schizophrenia; Health service; Indicator; Recommendation; Psychosis; Health policy; Treatment; Public health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/ps.2008.59.7.782

The aim of this study was to develop indicators of conformance in clinical practice with guidelines for care in schizophrenia. Recommended guidelines rarely apply to all patients and need to allow for social ability, family context, and phase of the disorder. These indicators were therefore devised for tailoring to patient characteristics and allowing for factors that may justify the lack of adherence to clinical guidelines. A team of senior clinicians and methodologists reviewed three clinical guidelines (from the Schizophrenia Patient Outcomes Research Team, McEvoy and colleagues, and the National Institute for Health and Clinical Excellence) and defined criteria for their operationalization into clinical indicators. For each indicator, the team defined criteria for eligibility (requirements to be met to qualify for evaluation), conformance (criteria to be satisfied to comply with each recommendation), and moderators (factors that could justify the lack of application of a given recommendation). These indicators were tested with a random sample of 807 patients with schizophrenia or schizoaffective disorders in outpatient facilities, long-term residential facilities, and hospital units for acute care in the Piedmont region of Italy. A set of 15 indicators was derived, nine concerning pharmacological treatment and six for general care and psychosocial rehabilitation. Moderators such as patient or family refusal of antipsychotic treatment and the patient's level of disability helped to justify a considerable proportion of nonconformant care. The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.