Improving evidence based practice in psychiatry : a trial prescribing guideline

Introduction: When attempting to implement evidenced based findings and guidelines, focused multi-faceted implementation strategies that address barriers to change appear more effective than dissemination strategies alone. There has been limited implementation research in psychiatry. The preparatory work for an implementation trial focusing on prescribing in schizophrenia is outlined. Objective: To design and assess the effectiveness of a multi-faceted intervention to implement a prescribing guideline aimed at reducing antipsychotic polypharmacy. Methods: The trial was designed as a pragmatic cluster randomised controlled trial set in 19 general adult psychiatric units in 4 South-West England trusts. The participants were all ward doctors and nurses. The intervention comprised: a manual reminder system; a staff workbook; and an educational visit t6 consultants. The control units received a guideline alone. Outcome measures were: cross-sectional rate of antipsychotic polypharmacy prescribing (primary); a beliefs questionnaire regarding antipsychotic polypharmacy (secondary) at baseline and 6 months (post-intervention). Pre-defined regression models accounted for the clustering and relevant confounders. Results: The primary outcome analysis showed that prescribing was significantly reduced in the intervention group compared to control when adjusting for stratifying variables and baseline (OR = 0.43, 95% CI 0.21-0.90, p=0.03). There was considerable, between unit, variation in the degree of change. There was a significant change in the expected direction in two out of three belief-related factors as measured by the secondary outcome measure and directly addressed by the workbook. Conclusions: The intervention appeared to be effective in implementing a guideline for this prescribing issue. The effect, however, was modest and the limitations of the methodology are explored. Although belief change appears to be due to the effect of the workbook, further work is needed to elicit which parts of the intervention were important in changing prescribing behaviour. The use of such multi-faceted interventions in implementing evidence-based psychiatry appears promising.EThOS - Electronic Theses Online ServiceGBUnited Kingdo