The Effectiveness of Guideline Implementation Strategies on Improving Antipsychotic Medication Management for Schizophrenia
Bibliographic Data
| ID | 9101586 |
|---|---|
| Authors | Richard R Owen (0000-0003-2548-2264, Central Arkansas Veterans Healthcare System, corresponding author), Teresa J Hudson (0000-0002-6672-6774, Health Services Research & Development, corresponding author), Teresa Hudson, Carol R Thrush (0000-0002-1877-5002, Office of Education), Carol Thrush, Purushottam Thapa, Purushottam B Thapa (Behavioral Health Services), Tracey Armitage (Central Arkansas Veterans Healthcare System, corresponding author), Reid D Landes (0000-0002-6349-0081) |
| Year | 2008 |
| Volume | 46 |
| Issue | 7 |
| Pages | 686-691 |
| Publication date | 2008-07-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e3181653d43 |
| PMID | 18580387 |
| OpenAlex | W2073143096 |
| Language | EN |
| Citations received | 3 |
| References cited | 32 |
OBJECTIVES: To compare the effectiveness of a conceptually-based, multicomponent "enhanced" strategy with a "basic" strategy for implementing antipsychotic management recommendations of VA schizophrenia guidelines. METHODS: Two VA medical centers in each of 3 Veterans Integrated Service Networks were randomized to either a basic educational implementation strategy or the enhanced strategy, in which a trained nurse promoted provider guideline adherence and patient compliance. Patients with acute exacerbation of schizophrenia were enrolled and assessed at baseline and 6 months and their medical records were abstracted; 291 participants were included in analyses. Logistic regression models were developed for rates of: (1) switching patients from first-generation antipsychotics (FGA) to second-generation antipsychotics (SGA), and (2) guideline-concordant antipsychotic dose. RESULTS: Of participants prescribed FGAs at baseline, those at enhanced sites were significantly more likely than participants at basic sites to have an SGA added to the FGA during the study (29% vs. 8%; adjusted OR = 7.7; 95% CI: 2.0-30.1), but were not significantly more likely to be switched to monotherapy with an SGA (29% vs. 23%). Guideline-concordant antipsychotic dosing was not significantly affected by the intervention. CONCLUSIONS: The enhanced guideline implementation strategy increased addition of SGAs to FGA therapy, but did not significantly increase guideline-recommended switching from FGA to SGA monotherapy. Antipsychotic dosing was not significantly altered. The study illustrates the challenges of changing clinical behavior. Strategies to improve medication management for schizophrenia are needed, and must incorporate recommendations likely to emerge from recent research suggesting comparable effectiveness of SGAs and FGAs
Antipsychotic · Guideline · Medication adherence · MEDLINE · Political science · Psychiatry · Schizophrenia (object-oriented programming) · Health Policy Implementation Science · Healthcare Decision-Making and Restraints · Internal Medicine · Medicine · Schizophrenia research and treatment
Detecting Alcoholism
Patterns of Usual Care for Schizophrenia
Translating Research Into Practice
Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia
Changing Provider Behavior
Use of Pharmacy Data to Assess Quality of Pharmacotherapy for Schizophrenia in a National Health Care System
| Unique citing works | 3 |
|---|---|
| Citations per year | 0,18 |
| Citation span | 2009 - 2018 (10) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 2 |