Implementation of a schizophrenia practice guideline: clinical results.
BACKGROUND
In mental health care, a range of guidelines with sound methodology is available; however, implementation studies in routine care are scarce.


METHODS
In a controlled before-and-after study design, the pharmacologic part of the German evidence-based schizophrenia guideline was implemented using a quality-circle-based intensive implementation program. 151 adult inpatients with a diagnosis of schizophrenia or schizo-affective disorder (according to ICD-10 criteria) were assessed in 4 psychiatric wards before (N = 77) and after (N = 74) guideline implementation. Treatment process and patient outcome were assessed at admission and discharge using the Positive and Negative Syndrome Scale (PANSS) and predefined process measures. A propensity score model adjusted for baseline psychopathology and sociodemographic variables was used. Data were collected from April to September of 2005 and from January to May of 2006 for the preintervention and postintervention periods, respectively.


RESULTS
After guideline implementation, the rate of antipsychotic monotherapy at discharge increased from 39.5% to 67.6% (p = .021) and the incidence of significant neurologic side effects decreased from 26.3% to 7.0% (p = .038). Antipsychotic dosage and prescriptions of other psychotropic drugs did not change. Although patients in the postintervention group were more severely disturbed at baseline, the reduction in PANSS total score was significantly greater among this group than among the preintervention group (p = .048).


CONCLUSIONS
After guideline implementation, we observed significantly more antipsychotic monotherapy and a decrease in adverse drug effects. Changing physician behavior and improving process and outcome measures requires intense efforts.
Weinmann
Stefan
S
Department of Psychiatry and Psychotherapy II, University of Ulm, Ulm, Germany. Stefan.Weinmann@gmx.de
Hoerger
Susanne
S
Erath
Monika
M
Kilian
Reinhold
R
Gaebel
Wolfgang
W
Becker
Thomas
T
D000328:Adult; D015992:Body Mass Index; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*