The effectiveness of guideline implementation strategies on improving antipsychotic medication management for schizophrenia

被引:21
|
作者
Owen, Richard R. [1 ,2 ]
Hudson, Teresa [1 ,2 ]
Thrush, Carol [3 ]
Thapa, Purushottam [2 ,4 ]
Armitage, Tracey [1 ]
Landes, Reid D. [5 ]
机构
[1] Cent Arkansas Vet Healthcare Syst, Ctr Mental Healthcare & Outcomes Res, VA Hlth Serv Res & Dev, N Little Rock, AR 72114 USA
[2] Univ Arkansas Med Sci, Coll Med, Dept Psychiat & Behav Sci, Little Rock, AR 72205 USA
[3] Univ Arkansas Med Sci, Off Educ Dev, Little Rock, AR 72205 USA
[4] Arkansas Dept Human Serv, Div Behav Hlth Serv, Little Rock, AR USA
[5] Univ Arkansas Med Sci, Coll Med, Dept Biostat, Little Rock, AR 72205 USA
关键词
schizophrenia; guideline implementation; medication management; antipsychotic agents;
D O I
10.1097/MLR.0b013e3181653d43
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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% Cl: 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.
引用
收藏
页码:686 / 691
页数:6
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