Developing clinical standards for schizophrenia in Scotland : How useful are Cochrane reviews?

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Hunter R, Lang F

Background: The Clinical Standards Board for Scotland (CSBS) are developing national standards for the management of people with schizophrenia. These standards will be introduced across Scotland and the mental health services of each Trust will be audited to measure compliance. Fourteen standards are initially being developed based on accepted good practice and research evidence. The purpose of this study was to ascertain to what extent the standards can be based on existing systematic reviews of the Cochrane Schizophrenia Group.

Methods: Draft standards were developed by a consensus finding approach in 14 important areas of care for people with schizophrenia. Evidence for the rationalle section of each standard was collected using the following search strategy: Cochrane Systematic Reviews Database, Cochrane Register of Clinical Trials, Guidelines from other world centres, MedLine, Embase, PsycLit. Evidence was graded A, B and C according to the US Department of Health and Human Resources (1993), as used by the Scottish Intercollegiate Guidelines Network (SIGN, 1999).

Results: The CSBS Standards for the care and treatment of people with schizophrenia will be described. Results will be presented to show the number of standards based on Grade A evidence from Cochrane Reviews and RCTs. Much of the evidence for the Standards was observational and graded at level C namely uncontrolled studies or expert opinion. In order to improve the evidence base, areas for future research will be identified.

Commentary: Despite 54 completed reviews and 38 protocols in schizophrenia (The Cochrane Library, 2000 Issue 1) this work shows that the evidence base for consensual standards for the management of people with schizophrenia is relatively weak. For some standard areas the evidence base is stronger and in a few areas Cochrane Systematic Reviews exist to inform standard setting. These findings clearly indicate the scope for further Cochrane reviews. Given that the standards represent a broad consensus in Scotland of how people with schizophrenia should be treated, there is clearly a pressing need for more systematic reviews. In addition it is important that existing reviews are regularly updated and improved. References: 1. Scottish Intercollegiate Guidelines Network (1999). SIGN Guidelines. An Introduction to SIGN methodology for the development of evidence-based clinical guidelines. 2. US Department of Health and Human Resources (1993). Clinical Practice Guideline No 1. Agency for Health Care Policy and Research Acute Pain Management: Operative or Medical Procedures and Trauma. Rockville: AHCPR Publication No 92-0023, p107.