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Developing and implementing clinical guidelines: lessons from the NICE Schizophrenia Guideline

Published online by Cambridge University Press:  18 May 2011

Stephen Pilling*
Affiliation:
National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Department of Psychology, University College, London (United Kingdom) Camden and Islington Mental Health and Social Care Trust, London (United Kingdom)
Katy Price
Affiliation:
National Collaborating Centre for Mental Health, College Research and Training Unit, Royal College of Psychiatrists, London (United Kingdom)
*
Address for correspondence: S. Pilling, CORE - Sub-dept Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB (United Kingdom). Fax: +44(0)20 7916 8511 E-mail: s.pilling@ucl.ac.uk

Summary

This paper describes the development of the clinical practice guideline on schizophrenia from the National Institute for Clinical Excellence (NICE) and outlines its main recommendations. It reviews the evidence on effective implementation of guidelines generally and examines issues specific to the schizophrenia guideline. It describes NICE'S approach to supporting implementation alongside that developed by the National Collaborating Centre for Mental Health (NCCMH) and looks at local implementation examples for schizophrenia.

The paper highlights key considerations for the forthcoming revision of the NICE schizophrenia guideline. It makes recommendations concerning the scope of the guideline and the quality and type of data available to the guideline developers: the lack of data on outcomes such as quality of life and social functioning, the challenges presented by unpublished papers and areas where evidence is limited. Since publication of the schizophrenia guideline, the NICE development process has undergone significant methodological improvements. The grading of evidence has been refined and more recently NICE proposed that grading of recommendations be dropped. Consensus methods are increasingly and more effectively used to deal with areas where the evidence-base is limited. NICE and the NCCMH have developed a more implementation-ready range of guideline products.

The initial NICE guideline on schizophrenia was positively received nationally and internationally. This paper highlights challenges that will be involved in updating the guideline and ways to refine the methodology of development. Ultimately the impact of the guideline will be measured not in its methodological rigor but in how its successful implementation improves patient care.

Declaration of Interest: Stephen Pilling in receipt of funding from NICE for the production of clinical guidelines.

Type
Special Articles
Copyright
Copyright © Cambridge University Press 2006

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References

REFERENCES

Aymerich, M., Guillamón, I., San Emeterio, M., Teixido, M., Sánchez, I., Faus, G., Lalucat, L. & Martínez, C. (2004 ). Clinical practice guidelines in schizophrenia: How to select the best one? Schizophrenia Research 67, 1, Suppl. 1, 139.Google Scholar
Carra, G., Barale, F. & Marinoni, A. (2004). Schizofrenia: Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica (edizione italiana). Il Pensiero Scientifico Editore: Roma.Google Scholar
Department of Health (2004a). Variations in usage of cancer drugs approved by NICE Report of the Review undertaken by the National Cancer Director. Retrieved June 10, 2006, from www.dh.gov.ukGoogle Scholar
Department of Health (2004b). Implementation of NICE guidance, Letter to the NHS from Lord Norman Warner. Retrieved June 10, 2006, from www.dh.gov.ukGoogle Scholar
Department of Health (2004c). National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06–2007/08. HMSO: London.Google Scholar
Gaebel, W., Weinmann, S., Sartorius, N., Rutz, W. & Mclntyre, J.S. (2005). Schizophrenia practice guidelines: international survey and comparison. British Journal of Psychiatry 187, 248255.CrossRefGoogle ScholarPubMed
Gournay, K. (2005). The changing face of psychiatric nursing. Advances in Psychiatric Treatment 11, 611.CrossRefGoogle Scholar
Grimshaw, J., Thomas, R., Maclennan, G., Fraser, C., Ramsay, C.R., Vale, L., Whitty, P., Eccles, M.P., Matowe, L., Shirran, L., Wensing, M., Dijkstra, R. & Donaldson, C. (2004). Effectiveness and efficiency of guideline dissemination strategies. Health Technology Assessment 8 (6), 184.CrossRefGoogle Scholar
Grol, R. & Jones, R. (2000). Twenty years of implementation research. Family Practice 17, Suppl 1, S3235.CrossRefGoogle ScholarPubMed
GRADE Working Group (2004) Grading quality of evidence and strength of recommendations. British Medical Journal 328, 1490.CrossRefGoogle Scholar
Hargreaves, S. (2003). NICE guidelines address social aspect of schizophrenia. British Medical Journal 326, 679CrossRefGoogle ScholarPubMed
Johnson, S., Nolan, F., Pilling, S., Sandor, A., Hoult, J., McKenzie, N., White, I.R., Thompson, M. & Bebbington, P. (2005). Randomised controlled trial of acute mental health care by a specialist crisis team: the north Islington crisis study. British Medical Journal 331, 559602.CrossRefGoogle Scholar
Killaspy, H., Bebbington, P., Blizard, R. et al (in press). The REACT study: A Randomised Evaluation of Assertive Community Treatment in North London. British Medical JournalGoogle Scholar
Lawson, D.; Sherman, V. & Hollowell, J. (1998). The General Practice Research Database. QJM 91, 445452.CrossRefGoogle ScholarPubMed
Mayor, S. (2002). People with schizophrenia must have a say in their treatment. British Medical Journal 325, 1317.CrossRefGoogle ScholarPubMed
Michie, S. & Johnston, M. (2004). Changing clinical behaviour by making guidelines specific. British Medical Journal 328, 343345.CrossRefGoogle ScholarPubMed
Michie, S. & Lester, K. (2005). Words matter: Increasing the implementation of clinical guidelines. Quality & Safety in Health Care 14, 367370.CrossRefGoogle ScholarPubMed
Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., Walker, A. & “Psychological Theory” Group. (2005). Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality & Safety in Health Care 14; 2633.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2003). Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Gaskell: London.Google Scholar
NICE (2002a). Clinical Guideline 1. Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. National Institute for Clinical Excellence: London.Google Scholar
NICE (2002b). The Guideline Development Methods - Information for National Collaborating Centres and Guideline Developers. National Institute for Clinical Excellence: London.Google Scholar
NICE, (2002c). Treating and Managing Schizophrenia (Core Interventions). Understanding NICE Guidance - Information for People with Schizophrenia, Their Advocates and Carers, and the Public. National Institute for Clinical Excellence: London.Google Scholar
NICE (2002d). Guidance on the Use of Newer (Atypical) Antipsychotic Drugs for the Ttreatment of Schizophrenia. Technology Appraisal No. 43. National Institute for Clinical Excellence: London.Google Scholar
NICE (2004). Self-harm: The Short-term Physical and Psychological Management and Secondary Prevention of Self-harm in Primary and Secondary Care. National Institute for Clinical Excellence: London.Google Scholar
NICE (2005a). How to Put NICE Guidance into Practice. National Institute for Clinical Excellence: London.Google Scholar
NICE (2005b), Proposals for Making the Guideline Development Process More Efficient: Consultation Document. National Institute for Clinical Excellence: London.Google Scholar
Petersen, L., Jeppesen, P., Thorup, A., Abel, M.B., Ohlenschlaeger, J., Christensen, T.O., Krarup, G., Jorgensen, P. & Nordentoft, M. (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, (7175) 602.CrossRefGoogle ScholarPubMed
Prescott, L.F., Illingworth, R.N., Critchley, J.A., Stewart, M.J., Adam, R.D. & Proudfoot, A.T. (1979). Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning. British Medical Journal 2 (6198), 10971100.CrossRefGoogle ScholarPubMed
Sheldon, T.A., Cullum, N., Dawson, D., Lankshear, A., Lowson, K., Watt, I., West, P., Wright, D. & Wright, J. (2004). What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews. British Medical Journal 329, 999.CrossRefGoogle ScholarPubMed
Startup, M., Jackson, M. & Pearce, E. (2002). Assessing therapist adherence to cognitive behavioural-therapy for psychosis. Behavioural and Cognitive Psychotherapy 30, 329339.CrossRefGoogle Scholar
Von Korff, M. & Goldberg, D. (2001). Improving outcomes of depression: the whole process of care needs to be enhanced. British Medical Journal 323, 948949.CrossRefGoogle Scholar
Whittington, C.J., Kendall, T., Fónagy, P., Cottrell, D., Cotgrove, A. &, Boddington, E. (2004). Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 363. 13411345.CrossRefGoogle ScholarPubMed