Making the use of psychotropic drugs more rational through the development of GRADE recommendations in specialist mental healthcare

International Journal of Mental Health Systems

Corrado Barbui⁴  Raffaella Rizzo²  Marianna Purgato⁴  Carlo Piazza³  Michela Nosè⁴  Francesco Nifosì²  Camilla Lintas¹  Giuseppe Imperadore²  Nicola Dusi⁴  Barbara-Vanessa Carrara²  Irene Bighelli⁴  Giovanni Ostuzzi⁴ 

[1] Unit of Psychiatry I, Verona, ULSS20, Italy;Unit of Psychiatry II, Verona, ULSS20, Italy;Unit of Psychiatry IV, Verona, ULSS20, Italy;WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Verona, Italy

关键词: Psychotropic drugs;    Mental healthcare;    Knowledge transfer;    Treatment guidelines;   

Others  :  801607
DOI  :  10.1186/1752-4458-7-14

 received in 2013-03-08, accepted in 2013-04-23,  发布年份 2013

【 摘 要 】

Introduction

In recent years the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology has often been used by international or national health authorities, or scientific societies, for developing evidence-based treatment recommendations. However, the GRADE approach has never been used by practicing physicians who aim at harmonizing their prescribing behaviours paying due attention to the best available evidence. This paper describes the experience of a working group of psychiatrists who adopted the GRADE approach to develop clinical recommendations on the use of psychotropic drugs in specialist mental healthcare.

Case description

The project was conducted in the Department of Mental Health of Verona, Italy, a city located in the north of Italy. At the beginning of 2012, psychiatrists with a specific interest in the rational use of psychotropic drugs were identified and appointed as members of a Guideline Development Group (GDG). The first task of the GDG was the identification of controversial areas in the use of psychotropic drugs, the definition of scoping questions, and the identification of outcomes of interest. The GDG was supported by a scientific secretariat, who searched the evidence, identified one or more systematic reviews matching the scoping questions, and drafted GRADE tables.

Discussion and evaluation

On the basis of efficacy, acceptability, tolerability and safety data, considering the risk of bias and confidence in estimates, and taking also into consideration preferences, values and practical aspects in favour and against the intervention under scrutiny, a draft recommendation with its strength was formulated and agreed by GDG members. Recommendations were submitted for consideration to all specialists of the Department, discussed in two plenary sessions open to the whole staff, and finally approved at the end of 2012.

Conclusion

The present project of guideline development raised several challenging and innovating aspects, including a “bottom-up” approach, as it was motivated by reasons that found agreement among specialists, those who developed the recommendations were those who were supposed to follow them, and values, preferences and feasibility issues were considered paying due attention to local context variables.

【 授权许可】

   
2013 Ostuzzi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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