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. SETTING AND PARTICIPANTS: 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. MAIN OUTCOME MEASURE: 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.
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. SETTING AND PARTICIPANTS: 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. MAIN OUTCOME MEASURE: 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.
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