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Leiden richtlijnen tot een betere klinische praktijk?
Samenvatting
Nadat in dit literatuuroverzicht is gebleken dat een zeer aanzienlijk deel van onze patiënten een evidence-based behandeling onthouden wordt in de dagelijkse psychiatrische praktijk, wordt aangetoond aan de hand van Australisch theoretisch onderzoek dat wanneer in de GGZ alleen nog evidence-based behandelingen zouden worden gegeven, er significant betere behandelresultaten zouden worden geboekt. Deze conclusie wordt bevestigd door diverse Randomised Controlled Trials waarin het effect van evidence-based behandeling volgens richtlijnen vergeleken wordt met ‘treatment as usual'. De literatuur onderstreept de complexiteit van kwaliteitsverbetering in de zorg. Implementatieonderzoek laat zien dat samengestelde en op maat gesneden interventies nodig zijn om trouw van de behandelaar aan richtlijnen te bewerkstelligen. Er moet meer onderzoek verricht worden naar effectieve manieren om richtlijnen adequaat te implementeren.
Summary
The effectiveness of evidence-based guidelines for psychiatric patients
From this literature review it appears that a major part of our psychiatric patients are not currently treated with evidence-based treatments. It has been theoretically shown that when these patients would be treated along the lines of evidence-based guidelines, the severity of their psychiatric complaints would decrease significantly and they would suffer from less adverse consequences. These results are corroborated with RCTs comparing the efficacy of evidence-based guidelines with treatment as usual. Effectiveness research yields, however, less optimistic results. Research into the methods of successfully implementation has shown that the effect of implementation of guidelines has limited effect on the change of the behaviour of professionals and subsequently on the improvement of psychiatric complaints of the patients. More research into this area is needed.
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