Study On Evaluation Of Clinical Guidelines On Mental Disorders In China

[Objectives](1) To evaluate the methodological quality of clinical guidelines onmental disorders in China.（2）To investigate the implementations and applications ofclinical guideline on schizophrenia in some areas of China.[Methods](1) Chinese clinical guidelines on mental disorders were identified bysearching Chinese National Knowledge Infrastructure, Chongqing VIP Database,WANFANG DATA, Chinese Biological Medical Literature Database, PubMed andother guideline websites, hand searches were also conducted under the help of peerexperts. Based on pre-defined inclusion and exclusion criteria, clinical guidelineswere selected to be evaluated using the Appraisal of Guidelines for Research andEvaluation (AGREE) Ⅱ. Foreign clinical guidelines on schizophrenia, anxietydisorders, mood disorders were also searched in the following databases: PubMed，BMJ Best Practice, Web of Science, DynaMed (EBSCO) and others. Commonguidelines related websites, such as National Guideline Clearinghouse (NGC),National Institute for Health and Clinical Excellence (NICE), Scottish IntercollegiateGuideline Network (SIGN), Guidelines International Network (G-I-N) were alsoused to identify the guidelines. After evaluation, the methodological qualitycomparisons were conducted between Chinese and foreign guidelines on the abovethree kinds of mental disorders（.2）Using the questionnaire of application status aboutChinese schizophrenia guideline, the anonymous survey was conducted withconvenient sampling among psychiatrists in some areas of China.[Results](1)15Chinese clinical guidelines on mental disorders met the inclusioncriteria, which were published from2006to2012and mostly developed by ChineseMedical Association. The AGREE Ⅱ median scaled domain scores of the15clinicalguidelines showed that the best-performing domains were clarity of presentation (76%)and scope and purpose (76%), and followed by stakeholder involvement (41%) andapplicability (40%). The rigour of development (30%) and editorial independence(3%) domains got the lowest scores. Through searching and selecting the foreign clinical guidelines, finally12guidelines for schizophrenia,22guidelines for anxietydisorders and32guidelines for mood disorders developed by foreign countries wereincluded to be evaluated. The AGREE Ⅱ median scaled domain scores of12guidelines on schizophrenia were92%,60%,70%,90%,31%and54%, in turn. Thesix median scaled domain scores of the22anxiety disorders guidelines were92%,53%,63%,88%,24%,46%respectively, and the scores of32mood disordersguidelines were86%,58%,61%,92%,24%,63%. The comparisons between Chineseand foreign clinical guidelines related to schizophrenia, anxiety disorders and mooddisorders indicated the scores of Chinese guidelines were lower than that of foreignguidelines in all domains except the applicability domain which got worse scores inboth Chinese and foreign guidelines.(2)325psychiatrists completed thequestionnaires about the application status of Chinese schizophrenia guideline in thesurvey, and318(97.8%) effective questionnaires were obtained.81.1%ofpsychiatrists who effectively completed the questionnaires reported they had heardabout the schizophrenia guideline. Of these,72.1%said they had read the guideline,which only accounted for58.5%of all the effective participants.96.2%ofpsychiatrists who had read the guideline reported using the guideline in clinicalpractice, even though most of them used the guideline partially. Participants reportedthe barriers most related to implementing the guideline were lack of publicity aboutguideline (63.2%), lack of understanding or familiarity (62.6%), divergence amongdifferent guidelines (58.2%), lack of government policies adapted with guidelineimplementation (54.7%). The participated psychiatrists also suggested some measuresto promote the implementation process, such as distributing a summary guideline orbooklet (70.3%), improving the compatibility between guidelines and nationalpolicies (55.5%), training through local medical associations (53.6%).[Conclusions](1) The overall methodological quality of the included Chineseclinical guidelines on mental disorders didn’t meet the criteria of AGREE Ⅱ well,especially in editorial independence, rigour of development and applicability domains.In future, AGREE Ⅱ should be widely used as a reference in the development orupdate of clinical guidelines on mental disorders in China.(2) The implementation status of Chinese schizophrenia guideline is unsatisfactory, and comprehensivemeasures should be taken to improve the Chinese schizophrenia guideline’simplementation and application.