Forsner Tord, Wistedt Anna Aberg, Brommels Mats, Forsell Yvonne
Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden.
BMC Psychiatry. 2008 Jul 25;8:64. doi: 10.1186/1471-244X-8-64.
The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines.
In this observational study four psychiatric clinics each participated in active implementation of the clinical guidelines for the assessment and treatment of depression and guidelines for assessment and treatment of patients with suicidal behaviours developed by The Stockholm Medical Advisory Board for Psychiatry. The implementation programme included seminars, local implementation teams, regular feedback and academic visits. Additionally two clinics only received the guidelines and served as controls. Compliance to guidelines was measured using indicators, which operationalised requirements of preferred clinical practice. 725 patient records were included, 365 before the implementation and 360 six months after.
Analyses of indicators registered showed that the actively implementing clinics significantly improved their compliance to the guidelines. The total score differed significantly between implementation clinics and control clinics for management of depression (mean scores 9.5 (1.3) versus 5.0 (1.5), p < 0.001) as well as for the management of suicide (mean scores 8.1 (2.3) versus 4.5 (1.9), p < 0.001). No changes were found in the control clinics and only one of the OR was significant.
Compliance to clinical guidelines measured by process indicators of required clinical practice was enhanced by an active implementation.
本研究的目的是在积极支持的实施过程之后，使用从指南中得出的结构化测量方法，衡量瑞典精神科护理临床指南的六个月依从性。
在这项观察性研究中，四家精神科诊所分别积极参与了由斯德哥尔摩精神医学咨询委员会制定的抑郁症评估与治疗临床指南以及自杀行为患者评估与治疗指南的实施。实施计划包括研讨会、本地实施团队、定期反馈和学术访问。此外，两家诊所仅接收了指南并作为对照。使用指标来衡量对指南的依从性，这些指标将首选临床实践的要求进行了操作化。共纳入725份患者记录，其中实施前365份，实施六个月后360份。
对所记录指标的分析表明，积极实施的诊所对指南的依从性显著提高。在抑郁症管理方面，实施诊所和对照诊所的总分存在显著差异（平均分分别为9.5（1.3）和5.0（1.5），p < 0.001），在自杀管理方面也是如此（平均分分别为8.1（2.3）和4.5（1.9），p < 0.001）。对照诊所未发现变化，且只有一个比值比具有显著性。
通过积极实施，以所需临床实践的过程指标衡量的对临床指南的依从性得到了提高。
