Article type
Year
Abstract
Background: Clinical practice guidelines have become a standard tool in the attempt to increase the quality of clinical care. They provide a guide to best practice and a framework within which clinical decisions can be made. Nevertheless, knowledge on how to best implement guidelines into mental healthcare is sparse.
Objectives: To investigate the efficacy of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore how guidelines should be translated into practice.
Methods: We performed a systematic review of randomised controlled trials (RCTs), controlled clinical trials and before-and-after studies comparing guideline implementation strategies versus usual care, and different guideline implementation strategies in patients with severe mental illness recruited in mental healthcare settings. We conducted a meta-analysis of RCTs only.
Results: Eighteen studies met our inclusion criteria. Overall, a minority of studies showed a positive statistically significant effect of guideline implementation on provider performance or patient outcomes, and often these studies employed a non-randomised design. The meta-analysis found no statistically significant effect of guideline implementation in terms of provider adherence to guidelines (odds ratio (OR) = 1.25, 95% CI 0.76 to 2.07; P value 0.38), whereas a statistically significant trend in favour of guideline implementation on patient outcomes was revealed (OR = 1.51, 95% CI 1.03 to 2.22; P value 0.04). The results did not show an advantage of guideline implementation strategies performed on professional and organisational level over strategies that only included professional interventions.
Conclusions: Current evidence is not sufficient to draw firm conclusions on the beneficial effects of guideline implementation on provider performance and patient outcome. Regarding the limited evidence, we were not able to determine the best way to translate guidelines into practice. In the light of numerous guidelines developed, there is a strong need for further research on this topic by applying optimised methods for the evaluation of guideline implementation.
Objectives: To investigate the efficacy of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore how guidelines should be translated into practice.
Methods: We performed a systematic review of randomised controlled trials (RCTs), controlled clinical trials and before-and-after studies comparing guideline implementation strategies versus usual care, and different guideline implementation strategies in patients with severe mental illness recruited in mental healthcare settings. We conducted a meta-analysis of RCTs only.
Results: Eighteen studies met our inclusion criteria. Overall, a minority of studies showed a positive statistically significant effect of guideline implementation on provider performance or patient outcomes, and often these studies employed a non-randomised design. The meta-analysis found no statistically significant effect of guideline implementation in terms of provider adherence to guidelines (odds ratio (OR) = 1.25, 95% CI 0.76 to 2.07; P value 0.38), whereas a statistically significant trend in favour of guideline implementation on patient outcomes was revealed (OR = 1.51, 95% CI 1.03 to 2.22; P value 0.04). The results did not show an advantage of guideline implementation strategies performed on professional and organisational level over strategies that only included professional interventions.
Conclusions: Current evidence is not sufficient to draw firm conclusions on the beneficial effects of guideline implementation on provider performance and patient outcome. Regarding the limited evidence, we were not able to determine the best way to translate guidelines into practice. In the light of numerous guidelines developed, there is a strong need for further research on this topic by applying optimised methods for the evaluation of guideline implementation.