Assessing adherence to guidelines with administrative data in psychiatric outpatients

Abstract

Rationale, aims and objectives To assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders using administrative data. Methods In a retrospective cohort study, we analysed routinely collected administrative data of 5346 patients, treated for mood, anxiety or somatoform disorders with pharmacotherapy, psychotherapy or a combination of both. Available administrative data allowed assessment of guideline adherence with a disorder-independent set of five quality indicators, assessing psychotherapy, pharmacotherapy, a combination of both and routine outcome measurements (ROM) during diagnostic and therapeutic phases. Associations between the socio-demographic variables age, gender, clinical diagnosis and treatment type on the one hand and non-adherence to guidelines were tested using logistic regression analysis. Results Patients were aged 39.5 years (SD 13.0) on average. The majority of patients were treated with a combination of pharmacotherapy and psychotherapy (50.1%), followed by psychotherapy (44.2%) and pharmacotherapy (5.6%). The majority of patients were suffering from a mood disorder (50.0%), followed by anxiety (43.9%) and somatoform disorders (6.1%). A diagnosis of anxiety or somatoform disorder was associated with higher odds of suboptimal duration [odds ratio (OR): 1.55 and 1.82[ and suboptimal frequency of psychotherapeutic treatment (OR of 0.89 and 0.63), and absence of ROM in the diagnostic phase (ORs 1.31 and 1.36, respectively) compared with depressive disorders. No ROM in the diagnostic phase was also predicted for by increasing age (ORs for the age categories of 56 and older of 1.48). Conclusions In this proof of principal study, we were able to assess some key indicators assessing adherence to clinical guidelines by using administrative data. Also, we could identify predictors of adherence with simple parameters available in every administrative data. Administrative data could help to monitor and aid guideline adherence in routine care, although quality may vary between settings.

Psychopathology and health-related quality of life as patient-reported treatment outcomes: evaluation of concordance between the Brief Symptom Inventory (BSI) and the Short Form-36 (SF-36) in psychiatric outpatients

“…Patients were treated according to evidence-based guidelines with pharmacological and/or psychological treatments (mainly Cognitive Behavior Therapy [37]). The Medical Ethical Committee of the LUMC approved the general study protocol regarding ROM, in which ROM is considered integral to the treatment process (no written informed consent is institutionally required for the analysis of anonymized data).…”

Development and implementation of guidelines for the management of depression: a systematic review

“…Such gaps in the development processes of existing guidelines may limit the implementation of guidelines for mood disorders. 147 – 149 Future guidelines for the management of depression should involve a combination of international and local collaboration, taking into consideration contextual factors that may facilitate or hinder access to health services or treatments. Contextual factors that may be relevant include, for example, structural or policy aspects of the health-care system, education and training; access to treatment methods for depression; and availability of modern technology.…”

Agents of change: establishing quality improvement collaboratives to improve adherence to Australian clinical guidelines for dementia care

“…Clinicians will be asked to provide a ‘snapshot’ of the consultation including its purpose, content, and outcomes. A process for guideline adherence scoring was modelled on methods used in Kortekaas et al [ 48 ] and van Fenema et al [ 49 ]. Key indicators of guideline adherence were developed in consultation with clinical and consumer experts (see Table 3 ).…”