Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
Curr Opin Psychiatry. 2013 Jul;26(4):369-75. doi: 10.1097/YCO.0b013e328361e7ae.
Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings.
Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts.
Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.
临床实践指南被视为精神卫生保健中不可或缺的资产,如果能得到适当的制定和实施。本文的目的是回顾现有文献,了解如何实施指南,以优化其对专科精神卫生保健环境中提供者绩效和患者结果的影响。
最近的研究结果表明,在实施指南后,过程和患者结果有改善的趋势。然而,这些研究在设计、实施策略和结果衡量方面存在异质性,使得很难就哪种实施策略在不同的医疗环境中有效得出确凿的结论。
目前关于如何实施指南的知识在精神卫生保健领域仍然匮乏和不确定。未来的研究应尝试采用更严格的设计,包括患者或患者群体的随机分配,以进一步阐明这一引人关注的问题。关于指南实施策略的研究还应考虑到知识转化的潜在障碍,这可能会严重影响治疗建议的实施性。