evidence- based practice for severe mental illness louisville hotel downtown may 20,2011

Evidence- Based PracticeFor Severe Mental Illness

Louisville Hotel DowntownMay 20,2011

Manoochehr Manshadi, M.D.Seven Counties Services,Inc

KyMAPKentucky Medication Algorithm Project

Antipsychotic Algorithm for PatientsDiagnosed with Schizophrenia

Algorithm

Algorithm and guidelines are often used interchangeably in the medical literature

All guidelines claim to be “evidence-based,”

Algorithm

Readers of these guidelines now must ask themselves a variety of questions in order to decide which guideline to apply in their clinical practice.

Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

Algorithm

Are the groups/committees developing these guidelines missing some of the evidence?

Are they using different criteria for evidence inclusion?


AlgorithmDoes one group have additional evidence that the others did not have available to them?

Do individuals involved in the guideline development have conflicts of interest?


Algorithm

Many guidelines often have little to no outside peer review and, at times, include individuals that may have various conflicts of interest.


AlgorithmGuidelines may serve two distinct purposes:1- Clinician guidance; and2- Administrative or organizational guidance.Keeping in mind the purpose and critiques

raised about all guidelines can assist clinicians in thoroughly evaluating those developed for the treatment of schizophrenia.


Barriers to Guideline Implementation

Many prescribers argue that: 1) guidelines and algorithms serve as a

form of “cookbook medicine” where everyone is treated the same and it removes the autonomy to choose what is best for my patients;



2) my patients are different or unique, such as, my patients are more ill, or my

practice setting is different (urban or rural), so the guideline information does not apply;



3) the evidence presented is not applicable to my patients because the studies exclude many of the patients and/or comorbid conditions I serve;



4)using guidelines takes more time and I am always behind schedule;

5)using guidelines adds more paperwork;

6) using guideline recommendations costs more money;



7) what I am already doing is working,so I have no need to change the way I

practice, “if it is not broke, don’t fix it,”8) None of my colleagues use them, so

why should I?


Overcoming the barriers to guideline implementation

Education involving providers in the

implementation process. Familiarizing clinicians with the

guidelines helps reduce potential resistance.


Conclusions

The actual utilization of guidelines and algorithms is variable and difficult to gauge.

Often, however, guidelines are treated as recommendations. Guidelines cover the most frequently

encountered situations. Guidelines are an important contribution to

clinical practice, and will continue to have an important place in medicine.


Conclusions

More and more emphasis is being placed on transparency of the guideline development process.

Clinicians want to know what evidence is being included or excluded, how the

evidence is synthesized and who is synthesizing it.

what their credentials are, and what possible conflicts of interest they may have with industry or organizations.


Conclusions

As the clarity improves in the guideline development process, hopefully the skepticism and reluctance of their use will dissipate.


evidence- based practice for severe mental illness louisville hotel downtown may 20,2011

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