Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden.
Implement Sci. 2010 Jan 26;5:4. doi: 10.1186/1748-5908-5-4.
The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects.The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation.
Six psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study.
The documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months.
Compliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance.
循证临床护理指南与实际应用之间的差距是众所周知且广泛存在的。尽管已经开展了一些精神科指南的实施研究，但缺乏对其长期效果的研究。本研究旨在测量在积极支持实施两年后，治疗抑郁症患者和有自杀行为患者的临床指南的依从性。
瑞典斯德哥尔摩的六家精神病诊所参与了指南的实施。其中四家积极实施了指南，另外两家只收到了指南并作为对照组。实施活动包括当地实施团队、研讨会、定期反馈和学术外展访问。使用从指南中得出的质量指标来衡量对指南的依从性。在基线时，从病历中提取了部分指南的质量指标测量值，以分析临床指南与当前实践之间的差距。在此基础上，根据当地需求举办了一系列研讨会，介绍指南。成立了当地多学科团队来监测该过程。在 6、12 和 24 个月后进行数据收集，共纳入 2165 份患者记录进行研究。
在四个积极实施的诊所中，质量指标的记录从基线开始有所改善，而在两个对照组诊所中则没有变化，或者有所下降。这种增加在六个月时就已经记录到了，并持续了 12 个月和 24 个月。
在积极实施后，对指南的依从性增加，并在两年的随访中保持不变。这些结果表明，涉及临床医生的临床指南的积极当地实施可以改变行为并保持依从性。
