Development of individual fitness score for conformity of prescriptions to the “Guidelines For Pharmacological Therapy of Schizophrenia”

Inada, Keiichi; Fukumoto, Kentaro; Hasegawa, Naomi; Yasuda, Yuka; Hori, Hikaru; Ichihashi, Kayo; Iida, Hitoshi; Ohi, Kazutaka; Muraoka, Hiroyuki; Kodaka, Fumitoshi; Ide, Kenta; Hashimoto, Naoki; Iga, Jun‐ichi; Ogasawara, Kazuyoshi; Atake, Kiyokazu; Takaesu, Yoshikazu; Nagasawa, Tatsuya; Komatsu, Hiroshi; Okada, Tsuyoshi; Furihata, Ryuji; Kido, Mikio; Kikuchi, Susumu; Kubota, Chika; Makinodan, Manabu; Ochi, Shinichiro; Takeshima, Masahiro; Yamagata, Hirotaka; Matsumoto, Junya; Miura, Kenichiro; Usami, Masahide; Kishimoto, Toshifumi; Onitsuka, Toshiaki; Katsumoto, Eiichi; Hishimoto, Akitoyo; Numata, Shusuke; Yasuda, Norio; Watanabe, Koichiro; Hashimoto, Ryota

doi:10.1002/npr2.12293

Cited by 5 publications

(10 citation statements)

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“…A low QI score does not necessarily indicate a clinical problem, and it is considered necessary to establish appropriate target values for each QI. We also recently developed an individual fitness score formula that expresses the degree to which prescribers adhere to the guidelines for schizophrenia and major depressive disorder 46,47 . An individual fitness score could be useful to visualize the degree to which current prescriptions conform to the guidelines for each patient.…”

Section: Discussionmentioning

confidence: 99%

“…We also recently developed an individual fitness score formula that expresses the degree to which prescribers adhere to the guidelines for schizophrenia and major depressive disorder. 46,47 An individual fitness score could be useful to visualize the degree to which current prescriptions conform to the guidelines for each patient. However, there is an important limitation.…”

Section: Pcn Psychiatry Andmentioning

confidence: 99%

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Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study

Hasegawa,

Yasuda,

Yasui‐Furukori

et al. 2023

Psychiatry Clin Neurosci

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AimThis study aims to examine the real‐world effectiveness of education regarding clinical guidelines for psychiatric disorders using ‘the Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)’ project.MethodsThe EGUIDE project is a nationwide prospective implementation study of two clinical practice guidelines, i.e., the Guideline for Pharmacological Therapy of Schizophrenia and the Treatment Guidelines for Major Depressive Disorders, in Japan. Between 2016 and 2019, 782 psychiatrists belonging to 176 hospitals with psychiatric wards participated in the project and attended lectures on clinical practice guidelines. The proportions of guideline‐recommended treatments in 7405 patients with schizophrenia and 3794 patients with major depressive disorder at participating hospitals were compared between patients under the care of psychiatrists participating in the project and those not participating in the project. Clinical and prescribing data on the patients discharged from April to September each year from participating hospitals of the project were also analyzed.ResultsThe proportions of three quality indicators (antipsychotic monotherapy regardless of whether other psychotropics medication, antipsychotic monotherapy without other psychotropics and no prescription of anxiolytics or hypnotics) for schizophrenia were higher among participating psychiatrists than among nonparticipating psychiatrists. As similar results were obtained in major depressive disorder, the effectiveness of the project for the dissemination of guideline‐recommended treatment has been replicated.ConclusionThis strategy of providing education regarding the clinical guidelines for psychiatric disorders was effective in improving the treatment‐related behavior of psychiatrists. The use of this education‐based strategy might contribute to resolving the mental health treatment gap.

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Section: Discussionmentioning

confidence: 99%

Section: Pcn Psychiatry Andmentioning

confidence: 99%

Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study

Hasegawa,

Yasuda,

Yasui‐Furukori

et al. 2023

Psychiatry Clin Neurosci

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“…In Japan, the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project, which aims to disseminate the guidelines that present the treatments for schizophrenia and major depressive disorder via education programs for psychiatrists, was reported to be effective 25–27 . In addition, to easily visualize the degree to which current prescriptions conform to the guidelines for the pharmacological treatment of schizophrenia, 24 the individual fitness score (IFS) is an effective tool, in which points vary in range from 0 to 100 28 . To prevent severe complications due to antipsychotic‐induced constipation, careful monitoring is needed for patients treated with high‐risk antipsychotics for constipation such as levomepromazine maleate, olanzapine, quetiapine, zotepine and clozapine.…”

Section: Discussionmentioning

confidence: 99%

“… 25 , 26 , 27 In addition, to easily visualize the degree to which current prescriptions conform to the guidelines for the pharmacological treatment of schizophrenia, 24 the individual fitness score (IFS) is an effective tool, in which points vary in range from 0 to 100. 28 To prevent severe complications due to antipsychotic‐induced constipation, careful monitoring is needed for patients treated with high‐risk antipsychotics for constipation such as levomepromazine maleate, olanzapine, quetiapine, zotepine and clozapine. In cases of severe constipation, decreasing the dose of antipsychotics or switching to low‐risk antipsychotics should be considered.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20‐year period: Retrospective cohort study

Kawamata,

Sugawara,

Sasaki

et al. 2023

Neuropsychopharm Rep

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BackgroundConstipation is a common adverse effect of antipsychotics, but little investigation has been conducted. We aimed to address the factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20‐year period.MethodsWe enrolled patients with schizophrenia attending each hospital (n = 14) from April 1, 2021, and retrospectively examined all prescriptions as of April 1, 2016, 2011, 2006, and 2001, every 5 years starting in 2021, for this population. 716 participants with complete data were included in the analysis. The Cochran Q test followed by Bonferroni correction and the Cochran–Armitage trend test were used to determine the differences and trends of the frequency of each laxative. Multivariate logistic regression analysis was performed to assess the factors on the initiation of laxative use over a 20‐year period.ResultsOf the patients, 25.1% were treated with laxatives in 2001, and 34.1% were treated in 2021. The numbers of patients treated with any laxatives significantly differed over the 20‐year period, with a significant increasing trend. In all laxatives, the numbers of patients treated with magnesium oxide, lubiprostone and elobixibat differed with a significant increasing trend. Female sex, age, the total DZP equivalent dose, and the doses of levomepromazine maleate, olanzapine, quetiapine, zotepine, lithium, and carbamazepine in 2021 were significant factors associated with the initiation of laxative use over the 20‐year period.ConclusionsCareful monitoring is needed for patients treated with levomepromazine maleate, olanzapine, quetiapine and zotepine. Optimizing prescriptions according to treatment guidelines could reduce antipsychotic‐induced constipation.

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“…However, we should assess several QIs according to multiple guideline recommendations; thus, a single indicator summarizing multiple QIs (with values ranging from 0 to 100 points) can facilitate evaluation of adherence to guideline recommendations. Recently, we developed an individual fitness score (IFS) in each patient to evaluate whether pharmacological treatments (prescriptions) in each clinician adhere to the Guidelines for Pharmacological Therapy of Schizophrenia (see Table 1 in the paper by Inada et al, 2022 ) and confirmed the validity of the IFS using a survey of the prescriptions at admission and discharge among EGUIDE project participants ( Inada et al, 2022 ). However, a combined evaluation of clinician adherence and patient outcomes is needed.…”

Section: Introductionmentioning

confidence: 93%

Relationships Between Adherence to Guideline Recommendations for Pharmacological Therapy Among Clinicians and Psychotic Symptoms in Patients With Schizophrenia

Kodaka

Ohi

Yasuda

et al. 2023

International Journal of Neuropsychopharmacology

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Background Clinician adherence to guideline recommendations in the pharmacological therapy of schizophrenia is important for favorable patient outcomes. To evaluate whether prescriptions followed the guidelines for pharmacological therapy of schizophrenia, we recently developed a summary indicator of multiple quality indicators: the individual fitness score (IFS). It is unclear whether adherence to the guidelines is related to patient outcomes. Here, we investigated correlations between the IFS values and psychotic symptoms in patients with schizophrenia. Methods We assessed whether patients’ current prescriptions adhered to the guideline recommendations using the IFS in 47 patients with treatment-resistant schizophrenia (TRS) and 353 patients with non-TRS (total n=400), respectively. Correlations between the IFS and total scores and scores on the five subscales of the Positive and Negative Syndrome Scale (PANSS). Furthermore, we explored correlations between over 2-year longitudinal changes in IFS values and changes in psychotic symptoms in some patients (n=77). Results We found significant negative correlation between the IFS and the PANSS total score in whole patients with schizophrenia (beta=-0.18, p=9.80×10 -5). The IFS was significantly and nominally negatively correlated with the PANSS total score in patients with non-TRS (Spearman’s rho=-0.15, p=4.40×10 -3) and in patients with TRS (rho=-0.37, p=0.011), respectively. The IFS was also significantly and nominally negatively correlated with several factors, such as the negative and depressed factors, in patients with non-TRS and in patients with TRS, respectively (p<0.05). Furthermore, the change in IFS values was marginally negatively correlated with the changes in PANSS total scores and scores on the positive and depressed factors (p<0.05). Conclusions These findings suggest that efforts to improve clinician adherence to guideline recommendations for pharmacological therapy of schizophrenia, as assessed by the IFS, may lead to better outcomes in patients with schizophrenia.

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Development of individual fitness score for conformity of prescriptions to the “Guidelines For Pharmacological Therapy of Schizophrenia”

Cited by 5 publications

References 16 publications

Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study

Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study

Factors associated with the initiation of laxative use in the same patients with schizophrenia over a 20‐year period: Retrospective cohort study

Relationships Between Adherence to Guideline Recommendations for Pharmacological Therapy Among Clinicians and Psychotic Symptoms in Patients With Schizophrenia

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