HSK Group, Oude Oeverstraat 120, 6811 JZ, Arnhem, The Netherlands.
Int J Ment Health Syst. 2012 Sep 20;6(1):20. doi: 10.1186/1752-4458-6-20.
Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment of anxiety disorders. An important question was whether it is feasible to implement these guidelines because implementing practice guidelines is often difficult. Although several implementation interventions have proven effective, there seems to be no ready-made strategy that works in all circumstances.
The Dutch multidisciplinary guidelines for anxiety disorders were implemented in a community mental health care centre, located in the east of the Netherlands. The centre provides secondary outpatient care. The unit within the centre that specializes in the treatment of anxiety disorders has 16 team members with diverse professional backgrounds. Important steps in the process of implementing the guidelines were analysing the care provided before start of the implementation to determine the goals for improvement, and analysing the context and target group for implementation. Based on these analyses, a tailor-made multifaceted implementation strategy was developed that combined the reorganization of the care process, the development of instruction materials, the organization of educational meetings and the use of continuous quality circles to improve adherence to guidelines.
Significant improvements in adherence rates were made in the aspect of care that was targeted for change. An increase was found in the number of patients being provided with recommended forms of psychotherapeutic treatment, ranging from 43% to 54% (p < 0.01). The delivery of adequate pharmacological treatment was not explicitly targeted for change remained constant.
The case study presented here shows that the implementation of practice guidelines for anxiety disorders in mental health care is feasible. Based on the results of our study, the implementation model used offers a useful approach to guideline implementation. By describing the exact steps that were followed in detail and providing some of the tools that were used in the study, we hope the replication of this implementation methodology is made more practical for others in the future.
近年来，一些国家大规模制定了精神障碍临床实践指南。在荷兰，自 2003 年以来已经制定了十多项针对精神卫生保健的多学科指南。第一个指南涉及焦虑障碍的治疗。一个重要的问题是实施这些指南是否可行，因为实施实践指南通常很困难。尽管一些实施干预措施已被证明是有效的，但似乎没有一种现成的策略适用于所有情况。
荷兰的焦虑障碍多学科指南在一家位于荷兰东部的社区精神卫生保健中心实施。该中心提供二级门诊护理。该中心专门治疗焦虑障碍的单位有 16 名具有不同专业背景的团队成员。在实施指南的过程中，重要的步骤包括分析实施前提供的护理，以确定改进的目标，以及分析实施的背景和目标群体。基于这些分析，制定了一个定制的多方面实施策略，将护理过程的重组、教学材料的开发、教育会议的组织以及使用持续质量圈结合起来，以提高对指南的依从性。
在针对变化的护理方面，遵医率有了显著提高。接受推荐的心理治疗形式的患者数量从 43%增加到 54%（p<0.01）。虽然没有明确针对改变的适当药物治疗的提供，但保持不变。
本案例研究表明，在精神卫生保健中实施焦虑障碍的实践指南是可行的。基于我们的研究结果，所使用的实施模型为指南实施提供了一种有用的方法。通过详细描述所遵循的确切步骤，并提供研究中使用的一些工具，我们希望将来其他人能够更实际地复制这种实施方法。
