Australian and New Zealand Clinical Practice Guidelines for Specialist Adult Mental Health Care: An Introduction

2003 ◽  
Vol 11 (1) ◽  
pp. 21-25 ◽  
Author(s):  
Philip Boyce ◽  
Peter Ellis ◽  
Jonine Penrose-Wall

Objective: To introduce, for College Fellows, Associates and Trainees and other readers of Australasian Psychiatry, the Australian and New Zealand Clinical Practice Guidelines for Specialist Adult Mental Health Care. Conclusions: For clinical practice guidelines to be applied appropriately and with confidence in practice, their development process, quality characteristics and limitations must be transparent to health systems, guideline users and consumers. Moreover, their status as evidence-based guidelines or consensus guidelines, or mixed-status guidelines, must be made explicit. This introduction to the Australian and New Zealand Clinical Practice Guidelines for Specialist Adult Mental Health Care is designed to assist you in implementing the guidelines in your practice. These are guidelines to assist practice. They are not a set of prescriptions about what to do. The process for developing the six guidelines is summarized. It involved over 70 individuals directly, who worked over a 2-year period in six independent guideline development teams to synthesize the research findings and to consult on draft recommendations. The teams included consumer and carer writing panels for most of the consumer guidelines. The series includes titles on schizophrenia; bipolar disorder; depression; panic and agoraphobia; anorexia nervosa; and deliberate self-harm. Full versions of the guidelines are to be published in the Australian and New Zealand Journal of Psychiatry. Consumer versions are published elsewhere. Extended versions and background material is available on the RANZCP website.

1999 ◽  
Vol 13 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Colin Macarthur ◽  
Liisa Jaakkimainen

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.


1996 ◽  
Vol 20 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Claire Palmer

The Clinical Practice Guidelines (CPG) Steering Group commissioned a survey to find out which areas of clinical practice the mental health community view as priority for the development of clinical practice guidelines (CPGs). Fifty per cent of all professionals and service users surveyed considered the assessment of risk and management of deliberate self-harm and dangerousness' a priority area for guideline development. These findings provided the basis for a successful bid to the Department of Health for the development of The Royal College of Psychiatrists' first CPG.


1995 ◽  
Vol 19 (7) ◽  
pp. 403-406 ◽  
Author(s):  
Sarah Marriott

Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient in clinical decisions about appropriate health care for specific clinical circumstances. The Royal College of Psychiatrists CPG Programme aims to develop clinical guidelines which are scientifically valid and acceptable to those affected by them. At the same time, CPGs must be responsive to advances in knowledge, and versatile enough for the demands of routine practice. Their development involves a number of stages and a variety of methods, built into a cycle of evaluation and review. The Programme has established priorities for clinical topics for CPG development through consultation with the mental health community. Well-developed CPGs would benefit clinicians, patients and purchasers of care. It Is now important to appraise their ability to change clinical practice, the associated direct and indirect costs, and their value as a medical technology. The clinical professions are in the strongest position to co-ordinate their development, and guide their evaluation.


Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 3
Author(s):  
Anisur Rahman

Bangladesh is a country with a large population. The health care needs of this huge population are met by a plethora of health care workers many of whom are not even trained formally for this work (traditional healers). Even in those who are trained in formal medicine we find doctors with various academic background and training. There is an amulgation of medical degrees which is not seen anywhere else in the world. As a result the diagnostic and clinical approach to patient varies widely. This setup denies the patient the standard of care that he or she deserves. In this context clinical practice guidelines can play a major role in standard patient care. Clinical practice guidelines are systematically developed to assist practitioners’ and patients' decisions about appropriate health care for specific clinical circumstances. Many terms have been developed including practice guidelines, practice standards, practice parameters, practice policies, protocols, algorithms, and critical paths, but the collective purpose is the same - reduction in unnecessary variability of care. Historically it started in USA, from attempts to monitor quality of care and cost of care. Experimental Medical Review Organizations were started in USA in 1971 by the National Center for Health Services Research and Development, which provided grants to assess quality of care. Legislation was signed into law as part of the Omnibus Reconciliation Act of 1989, creating the Agency for Health Care Policy and Research (AHCPR) [1]. A guideline is a stepwise evaluation of a clinical diagnosis or management strategy that requires observations to be made, decisions to be considered, and actions to be taken. Processes used during development of guidelines include informal and formal consensus methods, evidence-based methods, and explicit methods. Informal consensus method leads to poor quality and have been largely abandoned. Formal consensus development, based on the delphi technique is a stepwise process leading to recommendations that reflect the extent of agreement amongst individuals. This technique is limited in that it does not rely on explicit linkage between recommendation and the quality of the evidence reviewed. Evidence based methods have emerged with specific rules defined to link recommendations and supporting evidence [2]. Basic Steps in Guideline Development [3], [4] have been standardized by various international bodies and may be implemented in our country with a few adjustments. There are still methodological problems that have been identified. These include the needs to further define consistent definitions, to avoid publication bias, to maintain sensitivity to evolution in scientific understanding, and to develop criteria for validity of clinical research methods. Economic factors affecting guideline development also need to be avoided and include specialist interests, payer interests, and the need to disclose economic self interests [5]. A final problem is the challenge of disseminating already written guidelines to physicians and presents a formidable task unto itself and adds to the large burden of new data and information practitioners already have available. Guidelines should, therefore, be viewed as broad templates to assist physicians or patients in various clinical circumstances [6]. Clinical practice guideline is becoming an important determinant of how medicine and surgery is practiced in Western societies. It is time that this strategy is also introduced in Bangladesh to reduce variability in care, improve quality, measure outcomes, and reduces costs. It is expected of such institution as BCPS, and the professional bodies like Society of Surgeons and Association of Physicians of Bangladesh to initiate and implement such clinical guidelines.Prof. Dr. Anisur RahmanSenior Consultant & CoordinatorDepartment of General and Laparoscopic SurgeryApollo Hospitals DhakaReferencesGosfield A. Clinical practice guidelines and the law: applications and implications. In: Health Law Handbook. New York: Clark Boardman Callaghan; 1994:67-99.Roper WL, Winkenwerder W, Hackharth GM, Krakauer H. Effectiveness in health care: an initiative to evaluate and improve medical practice. NEJM. 1988; 319:1197-1202.American Medical Association. Office of Quality Assurance. Attributes to Guide the Development of Practice Parameters. Chicago.Schoenbaum SC, Sundwall DN, Reqman D. Using Clinical Practice Guidelines to Evaluate Quality of Care. AHCPR 95-0045, 1995;1&2.Ayres JD. The Use and Abuse of Medical Practice Guidelines. J Legal Med. 1994; 15:421-443.Tunis SR, Hayward R, Wilson MC. Internists’ attitudes about clinical practice guidelines. Ann Intern Med. 1994; 120:956-963.DOI: 10.3329/pulse.v3i1.6542Pulse Vol.3(1) July 2009 p.3


2015 ◽  
Vol 29 (6) ◽  
pp. 294-296 ◽  
Author(s):  
A Hillary Steinhart ◽  
Aida Fernandes

A series of clinical practice guidelines were recently developed by the Canadian Association of Gastroenterology (CAG) to provide clinicians with recommendations for the medical management of nonhospitalized ulcerative colitis (UC) patients. These guidelines were developed, reviewed and agreed on by expert clinicians and methodologists. Following the finalization of the guidelines, a group of patients with UC as well as several inflammatory bowel disease clinicians, were brought together for a half-day workshop to provide feedback from the patient perspective. At the workshop, the guideline development process was described and the guidelines were reviewed to ensure comprehension. Patients then had the opportunity to provide their insight to the relevance of the guideline development process and the content of the guidelines as it related to their personal experiences with UC. The patient group believed that, although the new guidelines will be a tremendous resource for the health care provider community, a more ‘lay-friendly’ version would better facilitate dialogue between patients and their health care practitioners. The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, in which patient preferences play a key role in determining the most appropriate therapy and dosing regimen, which, in turn, impact the likelihood of adherence to the treatment plan. It was also believed that quality of life issues were not fully addressed in the guidelines. Much could be learned from shared experiences and coping strategies that would empower patients to take charge of their health and become equal partners with their care providers.


2005 ◽  
Vol 39 (1-2) ◽  
pp. 1-30 ◽  
Author(s):  

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. Method: A comprehensive literature review (1990–2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. Treatment recommendations: This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3–5 years following diagnosis since course of illness is strongly influenced by what occurs in this ‘critical period’. Patients should not have to ‘prove chronicity’ before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at leasttwo antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no specialist involvement, while very common, is not regarded as an acceptable standard of care. Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.


2013 ◽  
Vol 26 (2) ◽  
pp. 103-111 ◽  
Author(s):  
Eunice Y. Pyon

Clinical practice guidelines (CPGs) are valuable tools for health care providers and support evidence-based medicine (EBM). Many organizations, including medical associations and government-affiliated agencies, develop and publish guidelines using varying methods. Unfortunately, many guidelines are not appropriately developed and certain recommendations are not based on the best available evidence. Recent efforts by EBM advocates are contributing to the improved quality of CPGs and more tools are becoming available to promote high-quality guideline development and use. This article describes the guideline development process and associated concerns and the advances in the field of CPGs. Tools to access and evaluate guidelines are also provided. Health care professionals equipped with an understanding of the process of guideline creation and tools for evaluation can appropriately utilize guidelines to improve patient care.


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