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Published Online: 1 December 2011

Adherence to Guidelines and Treatment Compliance in the Chilean National Program for First-Episode Schizophrenia

Niina Markkula, M.D., M.Sc. [email protected], Ruben Alvarado, M.D., Ph.D. [email protected], and Alberto Minoletti, M.D. [email protected]Authors Info & Affiliations
Publication: Psychiatric Services
Volume 62, Number 12
https://doi.org/10.1176/appi.ps.001042011
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Abstract

Objective:

Adherence to clinical guidelines for mental disorders among clinicians in industrialized countries is low. Research on guideline adherence among clinicians in lower- and middle-income countries is scarce. The purpose of this study was to evaluate the implementation of clinical guidelines for first-episode schizophrenia in the pilot phase of the Explicit Guarantees in Health (GES) program in Chile.

Methods:

Data were collected from 12 catchment areas in Chile, representing 58% of the public health system. Records for 20 patients from each site who were referred to the GES program with a tentative diagnosis of first-episode schizophrenia were reviewed. Adherence to first- and second-line antipsychotic treatments, use of diagnostic measures, and psychosocial interventions recommended in the guidelines were evaluated.

Results:

In the final sample of 110 patients, adherence to medication guidelines was good—86% received the recommended first-line antipsychotic. Psychoeducation was provided to 55% of patients and 49% of their families, but other psychosocial interventions were used more rarely. Use of symptom rating scales was low. At 12 months, 19% of patients had dropped out of treatment.

Conclusions:

Adherence to treatment guidelines in the Chilean GES program was remarkably good for pharmacological treatment, average for psychosocial interventions, and low for utilization of symptom scales and diagnostic measures. The dropout rate was low. (Psychiatric Services 62:1463–1469, 2011)

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Figures and Tables

Table 1 Diagnosis outcome of patients suspected of having a first episode of schizophrenia and referred to the Explicit Guarantees in Health program, by health service area of Chile
Table 2 Use of laboratory tests and imaging for 110 patients suspected of having a first episode of schizophrenia and referred to the Chilean Explicit Guarantees in Health program
Table 3 Pharmacological treatments received by 110 patients suspected of having a first episode of schizophrenia and referred to the Chilean Explicit Guarantees in Health program
Table 4 Services and treatments received by 110 patients suspected of having a first episode of schizophrenia and referred to the Chilean Explicit Guarantees in Health program
Table 5 Treatment status at 12 months of 98 patients suspected of having a first episode of schizophrenia and referred to the Chilean Explicit Guarantees in Health program

Information & Authors

Information

Published In

Go to Psychiatric Services
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Cover: Rushing Water, by John Singer Sargent, 1901�1908. Watercolor, gouache, and graphite on white wove paper. Gift of Mrs. Francis Ormond, 1950 (50.130.80c). The Metropolitan Museum of Art, New York. Image © The Metropolitan Museum of Art/Art Resource, New York.
Psychiatric Services
Volume 62 • Number 12 • December 2011
Pages: 1463 - 1469
PubMed: 22193794

History

Published online: 1 December 2011
Published in print: December 2011

Authors

Affiliations

Niina Markkula, M.D., M.Sc. [email protected]
Dr. Markkula is affiliated with the Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, Helsinki 00271, Finland (e-mail: [email protected]). She is also with the Faculty of Medicine, School of Public Health, University of Chile, Santiago, Chile, where Dr. Alvarado and Dr. Minoletti are affiliated.
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Ruben Alvarado, M.D., Ph.D. [email protected]
Dr. Markkula is affiliated with the Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, Helsinki 00271, Finland (e-mail: [email protected]). She is also with the Faculty of Medicine, School of Public Health, University of Chile, Santiago, Chile, where Dr. Alvarado and Dr. Minoletti are affiliated.
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Alberto Minoletti, M.D. [email protected]
Dr. Markkula is affiliated with the Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, Helsinki 00271, Finland (e-mail: [email protected]). She is also with the Faculty of Medicine, School of Public Health, University of Chile, Santiago, Chile, where Dr. Alvarado and Dr. Minoletti are affiliated.
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