Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-01T21:28:38.260Z Has data issue: false hasContentIssue false
  • English
  • Français

The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

Published online by Cambridge University Press:  11 April 2011

Mirella Ruggeri ,
Antonio Lora  and
Domenico Semisa
Mirella Ruggeri*
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezionedi Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Antonio Lora
Affiliation:
Dipartimento Salute Mentale, Azienda Ospedaliera di Vimercate, Vimercate (Milano)
Domenico Semisa
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
*
Address fo correspondence: Professor M. Ruggeri, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Policlinico G. B. Rossi, P.le L. A. Scuro 10, 37134 Verona. Fax: +39-045-812889 E-mail: mirella .ruggeri@univr.it
Get access Rights & Permissions [Opens in a new window]

Summary

Aims – To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT's Project (DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia ). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and c) evaluating their actual application in Italian MHSs. Methods – The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management. Results – The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementingspecific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process. Conclusions – The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocationprocesses that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.

Declaration of Interest: None.

Keywords

clinical guidelinesschizophreniapsychosisclinical routinecommunity mental health servicesguidelines implementation
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 358 - 368
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Brooker, C., Falloon, I., Butterworth, A., Goldberg, D., Graham-Hole, V. & Hillier, V. (1994). The outcome of training community psychiatric nurses to deliver psychosocial intervention. British Journal of Psychiatry 165(2), 222–230.Google Scholar
Burns, T., Catty, J., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschbach, J., White, S. & Wiersma, D.for the EQOLISE Group (2007). The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 370, 1146–1152.Google Scholar
Carrà, G., Barale, F. & Marinoni, A.(Eds.) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. Il Pensiero Scientifico Editore: Roma.Google Scholar
Catty, J., Lissouba, P., White, S., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschbach, J., Wiersma, D. & Burns, T.for the EQOLISE Group (2008). Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial. British Journal of Psychiatry 192, 224–231.Google Scholar
de Girolamo, G., Bassi, M., Neri, G., Ruggeri, M., Santone, G. & Picardi, A. (2007). The current state of mental health care in Italy: problems, perspectives, and lessons to learn. European Archives of Clinical Neurosciences 257, 83–91.Google Scholar
Dixon, L., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., Mueser, K., Miklowitz, D., Solomon, P. & Sondheimer, D. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services 52, 903–910.Google Scholar
Falzer, P., Moore, B. & Garman, M. (2008). Incorporating clinical guidelines through clinician decision-making. Implementation Science 3, 13.Google Scholar
Gaebel, W., Weinmann, S., Sartorius, N., Rutz, W. & McIntyre, J. S. (2005). Schizophreniapractice: International survey and comparison. British Journal of Psychiatry 187, 248–255.Google Scholar
Goldberg, D. (2008). Improved investment in mental health services: value for money? British Journal of Psychiatry 192, 88–91.CrossRefGoogle ScholarPubMed
Grol, R. (2001). Success and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care 39, 1146–1154.CrossRefGoogle ScholarPubMed
Haines, A. & Donald, A. (1998). Making better use of research findings British Medical Journal 317, 72–75.CrossRefGoogle ScholarPubMed
Joseph, R. & Birchwood, M. (2005). The national policy reforms for mental health services and the story of early intervention services in the United Kingdom. Journal of Psychiatry and Neuroscience 30(5), 362–365.Google Scholar
Kane, J. M. (2008). An evidence-based strategy for remission in schizophrenia. Journalof Clinical Psychiatry 69, Suppl 3, 25–30.Google Scholar
Killackey, E., Yung, A. R. & Mc Gorry, P. (2007). Early psychosis: Where we've been, where we still have to go. Epidemiologia e Psichiatria Sociale 16(2), 102–108.CrossRefGoogle ScholarPubMed
Kuipers, E. (2000). Psychological treatments for psychosis: evidence but unavailable. Psychiatric Rehabilitation Skills 4, 249–258.Google Scholar
Lasalvia, A. & Ruggeri, M. (2007). Assessing the outcome of community-based psychiatric care: building a feed-back loop from “real world” services research into clinical practice. In Multidimensional Outcomes in ‘Real World’ Mental Health Services. Follow-up Findings from the South Verona Outcome Project (ed. Lasalvia, A. and Ruggeri, M.). Acta Psychiatrica Scandinavica 116, Monograph Supplement No. 437.Google Scholar
Leucht, S. (2007). Psychiatric treatment guidelines: doctors non-compliance or insufficient evidence? Acta Psychiatrica Scandinavica 115, 417–419.CrossRefGoogle ScholarPubMed
Lora, A., Corlito, G., Miceli, M., Di Munzio, W., Lasalvia, A., Tanini, A., Mari, L., Casacchia, M., Cristofalo, D., Magnani, N., Semisa, D. & Ruggeri, M.per il Gruppo SIEP-DIRECT's (2008a). The treatment of acute episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 319–330.Google Scholar
Lora, A., Morganti, C., Erlicher, A., Burti, L., Buscaglia, G., Pegoraro, M., Jacchetti, D., Caneschi, A., Cristofalo, D., Ruggeri, M., Semisa, D.per il Gruppo SIEP-DIRECT's (2008b). Management of violent behaviour and rapid tranquillisation during acute episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 349–357.Google Scholar
Magliano, L., Marasco, C., Fiorillo, A., Marangone, C., Guarneri, M., Maj, M. & Working Group of the Italian National Study on Families of Persons with Schizophrenia (2002). The impact of professional and social support on the burden of families of patients with schizophrenia in Italy. Acta Psychiatrica Scandinavica 106, 291–298.CrossRefGoogle ScholarPubMed
Marshall, M., Crowther, R., Almaraz-Serrano, A., Creed, F., Sledge, W., Kluiter, H., Roberts, C., Hill, E. & Wiersma, D. (2008). Day hospital versus admission for acute psychiatric disorders Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD004026. DOI: 10.1002/14651858.CD004026.Google Scholar
McGlynn, E.A., Asch, S.M., Adams, J., Keesey, J., Hicks, J., De Cristofaro, A., Kerr, E.A. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine 348, 2635–2645.Google Scholar
McHugo, G. J, Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., Goldman, H. H., Lutz, W. J. & Finnerty, M. T. (2007). Fidelity outcomes in the National Implementing Evidence-Based Practices Project. Psychiatric Services 58(10), 1279–1284.CrossRefGoogle ScholarPubMed
Michie, S., Pilling, S., Garety, P., Whitty, P., Eccles, M. P., Johnston, M. & Simmons, J. (2007). Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory. Implementation Science Mar 26, 2–8.Google Scholar
National Collaborating Centre for Mental Health (2003). Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Gaskell: London.Google Scholar
Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G. & Morgan, C. (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine 32(5), 763–782.CrossRefGoogle ScholarPubMed
Rogers, J. A., Vergare, M. J., Baron, R. C. & Salzer, MS (2007). Barriers to recovery and recommendations for change: the Pennsylvania Consensus Conference on psychiatry's role. Psychiatric Services 58(8), 1119–1123.Google Scholar
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can theSIEP-DIRECT's Project serve in the search for a happy medium? Epidemiologia e Psichiatria Sociale 17(4), 270–277.Google Scholar
Ruggeri, M., Lasalvia, A., Salvi, G., Cristofalo, D., Bonetto, C. & Tansella, M. (2007). Applications and usefulness of routine measurement of patient's satisfaction with community-based mental health care. In Multidimensional Outcomes in ‘Real World’ Mental Health Services. Follow-up Findings From the South Verona Outcome Project (ed. Lasalvia, A. and Ruggeri, M.). Acta Psychiatrica Scandinavica 116, Monograph Supplement No. 437.Google Scholar
Ruggeri, M., Bacigalupi, M., Casacchia, M., Miceli, M., Morganti, C., Scavo, V., Allevi, L., Lupoi, S., Cristofalo, D., Lasalvia, A., Lora, A. & Semisa, D.per il Gruppo SIEP-DIRECT's (2008). Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 305–318.Google Scholar
Saxena, S. M. D., Lora, A., Ommeren, M. V, Barrett, T., Morris, J. & Saraceno, B. (2007). WHO's Assessment Instrument for Mental Health Systems: Collecting Essential Information for Policy and Service Delivery. Psychiatric Service 58, 816–821.Google Scholar
Seddon, M. E., Marshall, M. N., Campbell, S. M. & Roland, M. O. (2001). Systematic review of studies of quality of clinical health care in general practices in the United Kingdom, Australia and New Zealand. Quality in Health Care 10, 152–158.Google Scholar
Semisa, D., Lora, A., Morosini, P. & Ruggeri, M. (2008a). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence in the treatment of schizophrenia. The design the indicators, and the methodology of the study (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 278–290.CrossRefGoogle Scholar
Semisa, D., Lasalvia, A., Miceli, M., Dall'Agnola, R. B., Pucci, C., Bissoli, S., Visani, E., Pismataro, P., Vanetti, M., Pioli, R., Ruggeri, M. & Lora, A.per il Gruppo SIEP-DIRECT's (2008b). The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 291–304.Google Scholar
Semisa, D., Casacchia, M., Di Munzio, W., Neri, G., Buscaglia, G., Burti, L., Pucci, C., Corlito, G., Bacigalupi, M., Parravani, R., Roncone, R., Cristofalo, D., Lora, A. & Ruggeri, M.per il Gruppo SIEP-DIRECT's (2008c). Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 331–348.Google Scholar
Sheldon, TA, Cullum, N, Dawson, D, Lankshear, A, Lowson, K, Watt, I, West, P, Wright, D, Wright, J, (2004). What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes and interviews. British Medical Journal 329, 999–1004.Google Scholar
Tansella, M. (2004). Psichiatria bipolare, linee guida sui trattamenti, valutazione degli esiti. In Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica (ed. Carrà, G., Barale e, F., Marinoni, A.). Il Pensiero Scientifico Editore: Roma.Google Scholar
Tansella, M. (2007). The Long journey of monitoring and evaluating a new mental health service. In Multidimensional Outcomes in ‘Real World’ Mental Health Services. Follow-up Findings From the South Verona Outcome Project (ed. Lasalvia, A. and Ruggeri, M.). Acta Psychiatrica Scandinavica 116, Monograph Supplement No. 437.Google Scholar
Tansella, M., Amaddeo, F., Burti, L., Lasalvia, A. & Ruggeri, M. (2006). Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatrica Scandinavica, Suppl. No. 429, 90–94.Google Scholar
West, J. C., Wilk, J. E., Olfson, M., Rae, D. S., Marcus, S., Narrow, W. E., Pincus, H. A. & Regier, DA. (2005). Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Services 56(3), 283–291.Google Scholar