Chapter 39 Producing guidelines, protocols, and toolkits
Over the past several decades, multiple factors have resulted in the development of guidelines, treatment protocols, and implementation toolkits in all branches of medicine, including psychiatry.
First, a number of studies showed that some accepted practices could not be shown to be effective when tested in randomized controlled trials (RCTs: Coffman et al., 1987; Gaebel, 1995; Gaebel et al., 2002; Kinon et al., 1998). The lack of practice effectiveness in randomized studies is often attributed to the interventions not being well defined (Michie et al., 2009).
Second, community surveys showed that many evidence-based practices were either not used, or not used properly (i.e. not used with fidelity to the key details of implementation of the practice) (Buchanan et al., 2002; Cradock et al., 2001; Howard et al., 2009; Young et al., 1998). Fidelity refers to the degree to which a particular programme follows a programme model, which is a well-defined set of interventions and procedures that helps individuals achieve some desired goal (Bond et al., 2000).
Third, studies of incorporation of evidence-based practices into everyday practice showed long delays (Codyre et al., 2008; Rosen et al., 2007; Ruggeri et al., 2008). Meanwhile, evaluation of the impact of continuing medical education programmes demonstrated their ineffectiveness in changing physician practices (Davis et al., 1995). Thus, it became clear that to affect actual medical practices, it would be necessary to put together detailed sets of recommendations, and the means to operationalize them.
