Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
Oxford Health NHS Foundation Trust, Oxford, United Kingdom.
JMIR Ment Health. 2023 Dec 22;10:e52901. doi: 10.2196/52901.
BACKGROUND: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. OBJECTIVE: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. METHODS: The impact and clinical utility of the OxPPL guidance were assessed using clinicians' feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. RESULTS: Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. CONCLUSIONS: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates.
背景:在 COVID-19 大流行期间,牛津精准精神病学实验室(OxPPL)开发了针对心理健康护理指南的开放获取网络摘要(OxPPL 指南),涵盖数字方法和远程精神病学、自杀和自残、家庭暴力和虐待、围产期护理以及疫苗犹豫和精神疾病背景下的优先排序等关键领域,为及时的临床决策提供信息。
目的:本研究旨在以 OxPPL 指南为例,评估在卫生紧急情况下制定基于证据的卫生指南的实践。一个包括临床医生、研究人员和经验丰富的专家在内的国际临床站点和同事网络旨在:(1) 评估 OxPPL 指南的临床影响,作为指南摘要的一个例子;(2) 审查关于 COVID-19 大流行期间心理健康护理指南的其他基于证据的摘要;(3) 制定应对未来全球卫生紧急情况的框架。
方法:使用国际调查和焦点小组评估 OxPPL 指南的影响和临床实用性。一项系统评价(在开放科学框架上注册的方案)确定了在 COVID-19 大流行期间和之后针对心理健康护理的指南摘要或综合,并通过确定指南未包含的任何资源来评估 OxPPL 指南中使用的方法的准确性。
结果:总体而言,80.2%(146/182)的临床医生同意或强烈同意 OxPPL 指南回答了重要的临床问题,73.1%(133/182)表示指南与他们的服务相关,59.3%(108/182)表示指南对他们的临床实践有或有积极影响,42.9%(78/182)表示他们已经或将会分享该指南,80.2%(146/182)表示该方法可用于未来的卫生危机。焦点小组发现,基于证据的知识、临床观点和可见性的结合对于临床实施至关重要。系统评价确定了 2543 条记录,其中 2 项指南综合符合所有纳入标准,但只有 1 项(OxPPL 指南)使用了基于证据的方法。该综述表明,OxPPL 指南已包含大多数符合条件的指南,但有 6 项未包含。
结论:该研究确定了在 COVID-19 大流行期间对基于网络的、基于证据的心理健康护理指南存在未满足的需求。临床医生评估 OxPPL 指南具有实际的临床影响。需要健全的基于证据的方法和心理健康专业知识,但也需要易于访问,并且数字技术可以提供实质性帮助。进一步的卫生紧急情况是不可避免的,现在是准备的时候了,包括解决临床医生、患者和照顾者的培训需求,特别是在远程精神病学和数字心理健康等领域。对于未来的规划,应在国际平台上广泛传播指南,并分配资源以支持适应性更新。
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