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Evidence- Based Practice For Severe Mental Illness Louisville Hotel Downtown May 20,2011

Evidence- Based Practice For Severe Mental Illness Louisville Hotel Downtown May 20,2011 Manoochehr Manshadi, M.D. Seven Counties Services,Inc. KyMAP K entuck y M edication A lgorithm P roject Antipsychotic Algorithm for Patients Diagnosed with Schizophrenia. Algorithm.

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Evidence- Based Practice For Severe Mental Illness Louisville Hotel Downtown May 20,2011

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  1. Evidence- Based Practice For Severe Mental Illness Louisville Hotel Downtown May 20,2011 Manoochehr Manshadi, M.D. Seven Counties Services,Inc

  2. KyMAP KentuckyMedication Algorithm Project Antipsychotic Algorithm for Patients Diagnosed with Schizophrenia

  3. Algorithm Algorithm and guidelines are often used interchangeably in the medical literature All guidelines claim to be “evidence-based,”

  4. Algorithm Readers of these guidelines now must ask themselves a variety of questions in order to decide which guideline to apply in their clinical practice. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  5. Algorithm Are the groups/committees developing these guidelines missing some of the evidence? Are they using different criteria for evidence inclusion? Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  6. Algorithm Does one group have additional evidence that the others did not have available to them? Do individuals involved in the guideline development have conflicts of interest? Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  7. Algorithm Many guidelines often have little to no outside peer review and, at times, include individuals that may have various conflicts of interest. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  8. Algorithm Guidelines may serve two distinct purposes: 1- Clinician guidance; and 2- Administrative or organizational guidance. Keeping in mind the purpose and critiques raised about all guidelines can assist clinicians in thoroughly evaluating those developed for the treatment of schizophrenia. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  9. Barriers to Guideline Implementation Many prescribers argue that: 1) guidelines and algorithms serve as a form of “cookbook medicine” where everyone is treated the same and it removes the autonomy to choose what is best for my patients; Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  10. Barriers to Guideline Implementation 2) my patients are differentorunique, such as, my patients are more ill, or my practice setting is different (urban or rural), so the guideline information does not apply; Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  11. Barriers to Guideline Implementation 3) the evidence presented is not applicable to my patients because the studies exclude many of the patients and/or comorbid conditions I serve; Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  12. Barriers to Guideline Implementation 4)using guidelines takes more time and I am always behind schedule; 5)using guidelines adds more paperwork; 6) using guideline recommendations costs more money; Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  13. Barriers to Guideline Implementation 7)what I am already doing is working, so I have no need to change the way I practice, “if it is not broke, don’t fix it,” 8) Noneof my colleagues use them, so why should I? Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  14. Overcoming the barriers to guideline implementation Education involving providers in the implementation process. Familiarizing clinicians with the guidelines helps reduce potential resistance. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  15. Conclusions The actual utilization of guidelines and algorithms is variable and difficult to gauge. Often, however, guidelines are treated as recommendations. Guidelines cover the most frequently encountered situations. Guidelines are an important contribution to clinical practice, and will continue to have an important place in medicine. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  16. Conclusions More and more emphasis is being placed on transparency of the guideline development process. Clinicians want to know what evidence is being included or excluded, how the evidence is synthesized and who is synthesizing it. what their credentials are, and what possible conflicts of interest they may have with industry or organizations. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

  17. Conclusions As the clarity improves in the guideline development process, hopefully the skepticism and reluctance of their use will dissipate. Troy A. Moore ; Clinical Schizophrenia & Related Psychoses April 2011

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