Present addresses: Mental Health Service Administration, 2nd floor, 46 Nicholson Street, Fitzroy 3065, Australia
Fidelity to clinical guidelines using a care pathway in the treatment of first episode psychosis
Article first published online: 25 OCT 2010
© 2010 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 17, Issue 4, pages 722–728, August 2011
How to Cite
Petrakis, M., Hamilton, B., Penno, S., Selvendra, A., Laxton, S., Doidge, G., Svenson, M. and Castle, D. (2011), Fidelity to clinical guidelines using a care pathway in the treatment of first episode psychosis. Journal of Evaluation in Clinical Practice, 17: 722–728. doi: 10.1111/j.1365-2753.2010.01548.x
Work carried out at: Hawthorn Community Mental Health Service, 642 Burwood Road, Hawthorn East 3123, Australia
- Issue published online: 27 JUL 2011
- Article first published online: 25 OCT 2010
- Accepted for publication: 22 July 2010
- clinical practice guidelines;
- early psychosis
Objective To evaluate the implementation of clinical practice guidelines in the initial stages of treatment of first episode psychosis, through use of a care pathway within one area mental health service.
Methods A fidelity audit was undertaken using data from local Early Psychosis Care Pathway documents, completed for the cohort of clients with early psychosis seen in the first 2 years of an integrated early psychosis programme model, at St Vincent's Mental Health Service, Melbourne, Australia.
Results The utilisation of a care pathway greatly supported both the documentation of clinical process and fidelity to clinical guidelines in early psychosis treatment. Excellent adherence (over 80%) was achieved for therapeutic alliance with the client, conducting a comprehensive bio-psychosocial assessment, medical investigations, reduction of client trauma and increased orientation to the service and the mental health systems of care, and for contact with family. Good adherence (over 70%) was achieved for client re-integration to the community and promotion of carer well-being; the service plans to focus on these areas in future service improvement initiatives, along with a focus on physical health assessment and enhancing primary care liaison.
Conclusions The process of formally operationalizing and implementing clinical guidelines utilizing a care pathway within an area mental health service has proved to be an effective way to ensure fidelity with standard agency practices and protocols. The integrated approach, supported by quality assurance initiatives, provides an excellent goodness-of-fit within an established area mental health service.