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Implementation of a clinical practice guideline for schizophrenia in a specialist mental health center: an observational study

Overview of attention for article published in BMC Health Services Research, August 2016
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Title
Implementation of a clinical practice guideline for schizophrenia in a specialist mental health center: an observational study
Published in
BMC Health Services Research, August 2016
DOI 10.1186/s12913-016-1618-9
Pubmed ID
Authors

Ilan Fischler, Sanaz Riahi, Melanie I. Stuckey, Philip E. Klassen

Abstract

In mental health settings, implementation of and adherence to clinical practice guidelines (CPGs) is low. Strategies are needed to overcome barriers and facilitate successful implementation of CPGs into standard care. The goals of this study were to develop a framework for the implementation of a CPG for schizophrenia for hospitalized service users in a mental health care facility, and to monitor adherence to the guideline. An eight-step framework was developed based on project management principles: 1) the Appraisal Guideline for Research and Evaluation (AGREE) tool was used to rate and select a CPG; 2) an algorithm was created from the guideline; 3) a gap analysis identified clinical services and processes not conforming with the CPG recommendations; 4) a governance structure was created; 5) a modified Delphi process determined key outcome and process adherence metrics; 6) a project charter was developed; 7) clinical informatics ensured that systems and tools were in place to support the CPG; and 8) therapeutic services were realigned to match the requirements of the CPG within specified fiscal constraints. Percent adherence to the identified process adherence metrics was calculated before (March 2014) and for 12 months after implementation (April 2014-March 2015). The National Institute of Health and Care Excellence guideline scored highest on AGREE and was used to develop the algorithm. Cognitive behavior therapy for psychosis (CBT-P), art therapy and carer assessments were identified as gaps in care. Clinical global impression - Schizophrenia score was identified as the primary service user outcome variable and antipsychotic polypharmacy, metabolic monitoring, CBT-P referral and supported employment/vocational services referral as the primary process adherence measures. Adherence to guidance for metabolic monitoring (March 2014, 76.7 %; March 2015, 81.6 %), CBT-P referral (March 2014, 6.5 %; March 2015, 11.4 %) and vocational rehabilitation referral (March 2014, 36.6 %; March 2015, 49.1 %) were increased after CPG implementation. There was an initial increase in adherence to antipsychotic monotherapy (March 2014, 53.4 %; November 2014, 62.7 %), which decreased back toward baseline (March 2015, 55.1 %). The eight-step framework was used to implement a CPG process, though further quality improvements initiatives may be needed to improve adherence.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 57 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 57 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 12 21%
Student > Master 11 19%
Student > Ph. D. Student 8 14%
Student > Doctoral Student 5 9%
Unspecified 5 9%
Other 16 28%
Readers by discipline Count As %
Medicine and Dentistry 15 26%
Psychology 13 23%
Unspecified 9 16%
Nursing and Health Professions 6 11%
Pharmacology, Toxicology and Pharmaceutical Science 4 7%
Other 10 18%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 January 2018.
All research outputs
#10,996,278
of 12,373,969 outputs
Outputs from BMC Health Services Research
#3,791
of 4,092 outputs
Outputs of similar age
#189,691
of 226,130 outputs
Outputs of similar age from BMC Health Services Research
#6
of 8 outputs
Altmetric has tracked 12,373,969 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,092 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.4. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
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