An approach to measure compliance to clinical guidelines in psychiatric care.
BACKGROUND
The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines.


METHODS
In this observational study four psychiatric clinics each participated in active implementation of the clinical guidelines for the assessment and treatment of depression and guidelines for assessment and treatment of patients with suicidal behaviours developed by The Stockholm Medical Advisory Board for Psychiatry. The implementation programme included seminars, local implementation teams, regular feedback and academic visits. Additionally two clinics only received the guidelines and served as controls. Compliance to guidelines was measured using indicators, which operationalised requirements of preferred clinical practice. 725 patient records were included, 365 before the implementation and 360 six months after.


RESULTS
Analyses of indicators registered showed that the actively implementing clinics significantly improved their compliance to the guidelines. The total score differed significantly between implementation clinics and control clinics for management of depression (mean scores 9.5 (1.3) versus 5.0 (1.5), p < 0.001) as well as for the management of suicide (mean scores 8.1 (2.3) versus 4.5 (1.9), p < 0.001). No changes were found in the control clinics and only one of the OR was significant.


CONCLUSIONS
Compliance to clinical guidelines measured by process indicators of required clinical practice was enhanced by an active implementation.
Forsner
Tord
T
Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden. tord.forsner@ki.se
Wistedt
Anna Aberg
AA
Brommels
Mats
M
Forsell
Yvonne
Y
D000293:Adolescent; D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011570:Psychiatry / Q000592:standards*; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires