Fidelity to clinical guidelines using a care pathway in the treatment of first episode psychosis.
OBJECTIVE
To evaluate the implementation of clinical practice guidelines in the initial stages of treatment of first episode psychosis, through use of a care pathway within one area mental health service.


METHODS
A fidelity audit was undertaken using data from local Early Psychosis Care Pathway documents, completed for the cohort of clients with early psychosis seen in the first 2 years of an integrated early psychosis programme model, at St Vincent's Mental Health Service, Melbourne, Australia.


RESULTS
The utilisation of a care pathway greatly supported both the documentation of clinical process and fidelity to clinical guidelines in early psychosis treatment. Excellent adherence (over 80%) was achieved for therapeutic alliance with the client, conducting a comprehensive bio-psychosocial assessment, medical investigations, reduction of client trauma and increased orientation to the service and the mental health systems of care, and for contact with family. Good adherence (over 70%) was achieved for client re-integration to the community and promotion of carer well-being; the service plans to focus on these areas in future service improvement initiatives, along with a focus on physical health assessment and enhancing primary care liaison.


CONCLUSIONS
The process of formally operationalizing and implementing clinical guidelines utilizing a care pathway within an area mental health service has proved to be an effective way to ensure fidelity with standard agency practices and protocols. The integrated approach, supported by quality assurance initiatives, provides an excellent goodness-of-fit within an established area mental health service.
St Vincent's Mental Health Service, Hawthorn Community Mental Health Service, Melbourne, Vic., Australia. melissa.petrakis@svhm.org.au
Melissa
M
Petrakis
Bridget
B
Hamilton
Steve
S
Penno
Ajit
A
Selvendra
Simon
S
Laxton
Graeme
G
Doidge
Megan
M
Svenson
David
D
Castle
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D042241:Early Diagnosis; D017050:Episode of Care; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011618:Psychotic Disorders / Q000628:therapy*; D014739:Victoria; D055815:Young Adult