The Effectiveness of Guideline Implementation Strategies on Improving Antipsychotic Medication Management for Schizophrenia

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

• Partnership for Implementation of Evidence-Based Mental Health Practices in Rural Federally Qualified Health Centers

  Justin Hunt, Geoffrey M Curran et al.•Progress in community health…•2012

  Incluir item

• Characteristics of Medicaid Recipients Receiving Persistent Antipsychotic Polypharmacy

  Open Access•Robert O Cotes, David R Goldsmith et al.•Community Mental Health Journal•2018

  Incluir item

• Effect of Introducing a Care Pathway to Standardize Treatment and Nursing of Schizophrenia

  Open Access•Sara Marchisio, Michele Vanetti et al.•Community Mental Health Journal•2009

  Incluir item

• Detecting Alcoholism

  John A Ewing•JAMA•1984

  Incluir item

• Patterns of Usual Care for Schizophrenia

  Anthony F Lehman, D M Steinwachs et al.•Schizophrenia Bulletin•1998

  Incluir item

• Translating Research Into Practice

  Anthony F Lehman, D M Steinwachs et al.•Schizophrenia Bulletin•1998

  Incluir item

• Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia

  Jeffrey A Lieberman, T Scott Stroup et al.•New England Journal of Medicine•2005

  Incluir item

• The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

  Stanley R Kay, Abraham Fiszbein et al.•Schizophrenia Bulletin•1987

  Incluir item

• Changing Provider Behavior

  Jeremy M Grimshaw, Liz Shirran et al.•Medical Care•2001

  Incluir item

• Use of Pharmacy Data to Assess Quality of Pharmacotherapy for Schizophrenia in a National Health Care System

  Douglas L Leslie, Douglas Leslie et al.•Medical Care•2001

  Incluir item