title: Conformance to evidence-based treatment recommendations in schizophrenia treatment services.
abstract: OBJECTIVE
  To assess quality of health care provided in a representative Canadian mental health service using conformance to evidence-based treatment recommendations, and to examine differences from published US results.
  
  
  METHODS
  We used a cross-sectional cohort design involving a randomly selected sample of patients diagnosed with schizophrenia attending 1 of 3 mental health clinics in 1 Canadian regional health system. The sample size was calculated to detect differences with the US sample. Conformance criteria were based on a published protocol. Data were collected using patient interviews and a structured review of health records. Conformance to 9 key Schizophrenia Patient Outcomes Research Team recommendations was assessed.
  
  
  RESULTS
  Conformance ranged between 58% and 90% for pharmacological recommendations, and 0% to 81% for psychosocial recommendations. No patients who met criteria for assertive case management had been referred to an assertive case management team. Significant differences in conformance rates to some treatment recommendations were found between Canadian and published US results.
  
  
  CONCLUSIONS
  It proved possible to assess health care quality using process measures of conformance to treatment recommendations. Conformance to clinical recommendations for pharmacotherapy is higher than for psychosocial therapies. The absence of barriers to access for pharmacological therapies likely enhances the higher conformance to these recommendations. Limited or variable access to psychosocial services, specifically assertive community treatment, likely negatively affects conformance to psychosocial treatment recommendations. Methodological limitations preclude drawing conclusions on comparisons between Canadian and US services.
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. addingto@ucalgary.ca
authors.forename: Donald
authors.initials: D
authors.lastname: Addington
authors.forename: Emily
authors.initials: E
authors.lastname: McKenzie
authors.forename: Harvey
authors.initials: H
authors.lastname: Smith
authors.forename: Henry
authors.initials: H
authors.lastname: Chuang
authors.forename: Stephen
authors.initials: S
authors.lastname: Boucher
authors.forename: Beverly
authors.initials: B
authors.lastname: Adams
authors.forename: Zahinoor
authors.initials: Z
authors.lastname: Ismail
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002170:Canada; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012050:Rehabilitation, Vocational / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000628:therapy*
chemical_list: D014150:Antipsychotic Agents