title: Assessing adherence to guidelines for common mental disorders in routine clinical practice.
abstract: OBJECTIVE
  To measure the overall level of adherence to clinical guidelines with a set of cross-diagnostic process indicators in a randomly selected sample of outpatients who started an acute phase treatment for a common mental disorder in a routine clinical setting.
  
  
  METHODS
  
  
  
  METHODS
  We developed a generic set of quality measures to asses the implementation of guidelines in daily practice. This set was tested in a retrospective cohort study in a randomly selected sample of 300 outpatients who started an acute phase psychiatric treatment for various psychiatric disorders. Patients were treated with pharmacotherapy, psychotherapy or a combination of both.
  
  
  METHODS
  Scores on cross-diagnostic process indicators.
  
  
  RESULTS
  Most indicators were positive in a high to very high percentage, indicating that most treatment elements in this routine clinical practice setting were delivered according to the guidelines for the acute treatment phase. We observed significant lower scores in the combined treatment group as compared with the two other treatment groups on the indicators 'correct treatment module' and 'stepped care' (P ≤ 0.005). Patients receiving psychotherapy had the best results on the separate indicators. Overall, only a minority of the patients in this sample was treated in complete accordance with the guidelines and treatment manuals.
  
  
  CONCLUSIONS
  Assessment of guideline adherence is feasible with this cross-diagnostic set of process indicators and hampering factors of implementation could be easily detected. Future research should focus on the relationship with treatment outcomes.
authors.affiliation: Department of Psychiatry B1-P, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. e.m.vanfenema@lumc.nl
authors.forename: Esther
authors.initials: E
authors.lastname: Van Fenema
authors.forename: Nic J A
authors.initials: NJ
authors.lastname: Van Der Wee
authors.forename: Mark
authors.initials: M
authors.lastname: Bauer
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Witte
authors.forename: Frans G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012189:Retrospective Studies