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

Abstract

Aim: This 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.

Methods: The 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.

Results: The 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.

Conclusion: This 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.

Keywords: clinical practice guideline; dissemination; education; major depressive disorder; schizophrenia.

Fig. 1

Implementation strategy of the EGUIDE project. MDD, major depressive disorder; SZ, schizophrenia. The EGUIDE project is conducting guideline training, collecting the knowledge, attitude, and treatment of participants, and examining the outcomes of EGUIDE project participation (blue arrows). The certificated psychiatrists of the EGUIDE project are trained to understand the guidelines and to share their philosophy of this project. Participants received guideline training and instruction (equivalent to educational outreach visits) at each clinical institution. EGUIDE uses one‐way standard implementation strategies of guideline dissemination and validation activities (blue arrows). Certified psychiatrists obtain information from psychiatrists in clinical practice (orange arrows), which is a new implementation strategy.

Fig. 2

Longitudinal changes in QI values of patients with schizophrenia after participating in the EGUIDE educational program. EGUIDE (+), patients treated by psychiatrists who participated in the EGUIDE project; non‐EGUIDE, patients treated by psychiatrists who have never participated in the EGUIDE project; SQI, quality indicator of schizophrenia, (a) SQI‐1 – proportion of antipsychotic monotherapy regardless of whether other psychotropics medication, (b) SQI‐2 – proportion of antipsychotic monotherapy without other psychotropics, (c) SQI‐3 – proportion of no prescription of anxiolytics or hypnotics. Patients under the care of EGUIDE (+) psychiatrists were defined before participation (pre‐EGUIDE), at one year after participation (1 year), 2 years of participation (2 years) and 3 years of participation (3 years). Patients under the care of non‐EGUIDE psychiatrists were defined before starting the EGUIDE lecture (pre‐EGUIDE), at one year after EGUIDE (1‐year), 2 years after EGUIDE (2‐years) and 3 years after EGUIDE (3‐years). Logistic regression analysis was used to analyze the effect of the number of years since participation on QI values, adjusting for confounding factors, age, sex, and type of facilities. *P < 0.05, **P < 0.01, ***P < 0.001, n.s., not significant.

Fig. 3

Longitudinal changes in QI values of patients with major depressive disorder after participating in the EGUIDE educational program. DQI, quality indicator of major depressive disorder; EGUIDE (+), patients treated by psychiatrists who participated in the EGUIDE project; non‐EGUIDE, patients treated by psychiatrists who have never participated in the EGUIDE project, (a) DQI‐2 – proportion of antidepressant monotherapy without other psychotropics, (b) DQI‐3 – proportion of no prescription of anxiolytics or hypnotics. Patients under the care of EGUIDE (+) psychiatrists were defined before participation (pre‐EGUIDE), at one year after participation (1 year), 2 years of participation (2 years) and 3 years of participation (3 years). Patients under the care of non‐EGUIDE psychiatrists were defined before starting the EGUIDE lecture (pre‐EGUIDE), at one year after EGUIDE (1‐year), 2 years after EGUIDE (2‐years) and 3 years after EGUIDE (3‐years). Logistic regression analysis was used to analyze the effect of the number of years since participation on QI values, adjusting for confounding factors, age, sex, and type of facilities. *P < 0.05, **P < 0.01, n.s., not significant.