Implementing medication guidelines: The application of theory and research

APHA Scientific Session and Event Listing

Robert J. Constantine, PhD, Department of Mental Health Law and Policy, Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Blvd. MHC 2724, Tampa, FL 33612, 813-974-9018, rconstantine@fmhi.usf.edu and Rajiv Tandon, MD, Mental Health Program Office, State of Florida Dept. of Children and Families, 1317 Winewood Blvd., Tallahassee, FL 32399-0700.

Session Abstract

Concerns with cost and quality have led many public and private health plans to pursue the implementation of evidence based treatment guidelines for the pharmacologic treatment of major mental illnesses. However, achievement of widespread and sustained use of guidelines has remained elusive leading researchers to focus on the process of implementation. This paper reviews the resulting literature and identifies design principles that are associated with successful implementation. The background and content of a behavioral pharmacy management program implemented in Florida in the winter and spring of 2005 is described with emphasis on how the effort was informed by these principles. The paper describes the development and marketing of guidelines for the treatment of schizophrenia and bipolar disorder and the series of progressively intensive interventions that facilitated their use in clinical practice. The process included the periodic analysis of pharmacy claims against a series of guideline concordant quality edits that created a list of high priority target prescribers. Methods for strategically selecting the recipients of more intensive interventions are presented. The resulting “telescoping “ of activities that allowed the efficient use of a broad range of integrated interventions is described. These interventions included audit and feedback, coaching and follow-up, the use of educational materials targeted to specific prescriber behavior, peer-to-peer contacts and academic detailing, organization-based consultation and the application of decision support tools.

Learning Objectives:

At the conclusion of the session the participants will be able to

- discuss and evaluate the different approaches to medication guideline implementation that appear in the literature
- identify the key design principles that emerge from guideline implementation efforts and associated research
- articulate the components of a comprehensive guideline implementation program

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation

Evidence Based Practice in Mental Health

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA