Psychiatrists' Adoption of Schizophrenia Guidelines

有大量证据表明，精神分裂症的护理质量低于临床研究文献中得出的循证标准。对其他情况下不遵守指南的研究发现缺乏知识，与证据不一致，对有效实施指南的能力缺乏信心，以及对实施指南的组织障碍的感知。对于精神分裂症，实践和证据之间存在差距的原因尚不清楚。本研究将通过对提供直接病人的精神科医生的调查来解决这些问题。目标是：1)确定精神科医生用来了解精神疾病诊断和治疗进展的信息来源；2)评估精神分裂症PORT项目中制定的循证指南的一致性和依从性程度；3)检查精神科医生的特征、他们的实践和与采用循证指南相关的外部环境。4)评估精神科医生参与教育机会以提高其知识和实施指导方针的能力的意愿，以及他们对替代教育形式的偏好。调查样本将是马里兰州所有为患者提供直接护理的精神科医生。根据调查结果，精神科医生将根据学习风格（他们最有可能回应的方法和资源），采用基于指南的实践的准备情况（遵循Prochaska和DiClemente的准备改变模式）以及对精神分裂症的临床兴趣进行分类。在治疗精神分裂症或对精神分裂症感兴趣的患者中，将确定参与实践评估的意愿，以及对实践工具的感知需求，以克服实施基于指南的患者护理的障碍。这项研究的结果将用于设计马里兰州的教育干预试验，以改善对精神分裂症患者的护理。

There is substantial evidence that quality of care for schizophrenia falls short of evidence-based standards derived from the clinical research literature. Studies of non-adherence to guidelines for other conditions have found lack of knowledge, disagreement with the evidence, lack of confidence in ability to implement guidelines effectively, and perceived organizational barriers to their implementation. Reasons for the gap between practice and evidence are not known for schizophrenia. This study will address these issues through a survey of psychiatrists providing direct patient. The aims are: 1) To identify sources of information used by psychiatrists to learn about advances in diagnosis and treatment of psychiatric disorders, 2) To assess the extent of agreement with and adherence to evidence-based guidelines developed in the schizophrenia PORT project, 3) To examine characteristics of psychiatrists, their practices and the external environment associated with readiness to adopt evidence-based guidelines, and 4) To assess the willingness of psychiatrists to participate in educational opportunities to advance their knowledge about and ability to implement guidelines, and their preferences among alternative educational formats. The survey sample will be all psychiatrists in the state of Maryland who are providing direct patient care. Based on survey responses, psychiatrists will be classified by learning style (what methods and resources they are most likely to respond to), readiness to adopt guideline-based practices (following Prochaska and DiClemente's readiness to change model), and clinical interest in schizophrenia. Among those treating or having an interest in schizophrenia, willingness to participate in practice assessments will be determined, as will perceived need for practice tools to overcome barriers to implementation of guideline-based patient care. The findings of this research will be used to design educational intervention trials in Maryland to improve the care of patients with schizophrenia.