[Guideline compliance in the treatment of schizophrenic patients. Introduction of a computer-assisted treatment pathway].
BACKGROUND
The goal of S3 Guidelines for the Treatment of Schizophrenia was to improve the care of patients with schizophrenic psychoses. However, the publication of guidelines alone does not ensure their consistent implementation. The use of treatment pathways represents one possible approach to help implement the complex treatment recommendations contained in the S3 Guidelines. The first computer-assisted treatment pathway for patients with schizophrenic psychoses was successfully incorporated into the everyday routine of psychiatric hospitals. The aim of the present study was to systematically analyse the impact of this measure on guideline compliance.


METHODS
Based on the S3 Guidelines for the Treatment of Schizophrenia developed by the German Association of Psychiatry, Psychotherapy and Neurology (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde; DGPPN), diagnostic and treatment procedures were defined by a multiprofessional working group with members from five different hospitals and subsequently incorporated into an existing hospital information system. In one of the five hospitals, the impact of this measure was analysed in a pilot study in a systematic manner. In the year 2007, approximately 100 patients in each of two wards in the hospital received in a parallel group design either standard care or care based on a computer-assisted treatment pathway. Based on their place of residence, patients were assigned to the two units consecutively. Both groups were analysed to determine the extent to which the care they received conformed to treatment guidelines. Data available from the years 2004 and 2005 served as a historical comparison to the present results.


RESULTS
The differences in guideline compliance between the two wards were heterogeneous and, in certain respects, counterintuitive. As expected, the treatment pathway group showed an increased number of laboratory tests, more frequent drug screening at hospital admission and more appropriate dosing of neuroleptics. However, the rate of participation in psychoeducational interventions was disappointing. A conspicuous finding was the negative relationship between initial disease severity and compliance with guidelines on psychopharmacological treatment. In contrast, the historical comparison revealed that guideline compliance had increased slightly in both the treatment pathway and standard treatment groups.


CONCLUSIONS
Developing computer-assisted treatment pathways based on S3 Guidelines and incorporating them into existing hospital information systems is feasible and well accepted by users. The initial effects on guideline compliance are mostly positive, but not strongly so. Moreover, there was a reduction in duration of hospital stay. Disease-related factors such as disease severity appear to compromise guideline compliance.
Godemann
F
F
Zentrum für Neurologie, Psychiatrie und Psychotherapie, St.-Joseph-Krankenhaus, Berlin-Weissensee, Gartenstrasse 1, 13088, Berlin, Deutschland. f.godemann@alexius.de
Blittersdorf
K
K
Poschenrieder
M
M
Klimitz
H
H
Hauth
I
I
Gutzmann
H
H
D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012559:Schizophrenia / Q000453:epidemiology* / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000592:standards* / Q000706:statistics & numerical data*; D055815:Young Adult