[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].
OBJECTIVE
The aims of the SIEP-DIRECT'S Project (DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia) are: (1) To evaluate the appropriateness of the NICE guidelines for schizophrenia in Italian Departments of Mental Health; (2) to develop and to test a set of SIEP indicators, based on the NICE recommendations, useful to evaluate their real application in mental health services.


METHODS
Based on the NICE recommendations, 103 indicators have been developed, some of them qualitative and the rest quantitative. These indicators investigate five different areas: 14 indicators concern the common elements in all phases of mental health care; 11 the treatment of first episode; 24 the crisis treatment; 41 the recovery promotion; 13 the urgency, including management of violent behaviours and fast soothing. After a pilot study conducted in 2 community mental health services, the indicators were tested in 19 Italian Departments of Mental Health, to obtain a self-evaluation of the quality of care and to verify the application of NICE recommendations in the clinical routine of these Services. Data for the self-evaluation have been obtained from the DSM's psychiatric informative system and from the Direction of the local health authorities or of the DSM. Moreover, for some indicators, information has been gathered from the clinical records, and by means of questionnaires administered to a sample of patients and relatives. Finally, "multidisciplinary" (i.e., involving different types of professionals) or "specialized" (i.e., involving only psychiatrists) focus groups have assessed the degree of similarity between practice and recommendation for 33 indicators. Finally, the focus group methodology has been applied in all services with the aim to judge the appropriateness of each NICE recommendation in the context of the Italian Departments of Mental Health.


CONCLUSIONS
Most NICE recommendations have been considered useful and appropriated to measure quality of care in the context of the Italian services. The SIEP indicators have been easily used by the services participating in the DIRECT'S Project. The self-evaluation process has provided several data of great relevance to improve the quality of care for schizophrenia and implement clinical guidelines in Italy.
Semisa
Domenico
D
Dipartimento di Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti, Via Nicola Carnevale 7, 70021 Acquaviva delle Fonti, Bari. domenico.semisa@alice.it
Lora
Antonio
A
Morosini
Pierluigi
P
Ruggeri
Mirella
M
D003156:Community Mental Health Services / Q000592:standards*; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic / Q000592:standards*; D019984:Quality Indicators, Health Care; D012559:Schizophrenia / Q000628:therapy*; D012955:Societies, Medical