EFFECT OF EDUCATION REGARDING TREATMENT GUIDELINES FOR SCHIZOPHRENIA AND DEPRESSION ON THE TREATMENT BEHAVIOR OF PSYCHIATRISTS: A MULTICENTER STUDY
Authors: Hasegawa *Naomi , Yasuda Yuka , Yasui-Furukori Norio , Hori Hikaru , Ichihashi Kayo , Takaesu Yoshikazu , Iida Hitoshi , Muraoka Hiroyuki , Kodaka Fumitoshi , Matsumoto Junya , Miura Kenichiro , Inada Ken , Watanabe Koichiro , Hashimoto Ryota 
Published: February 2025

Abstract

Background
Evidence-based clinical practice guidelines (guidelines) are used to help people make well-informed decisions. A previous meta-analysis examining the effect of evidence-based guidelines for psychiatric disorders on patient health outcomes in specialist mental health care suggested that patients who undergo guideline-adherent treatments report better and faster improvements than patients treated with treatment-as-usual. Major guidelines for psychiatric disorders recommend monotherapy with antipsychotics for schizophrenia and monotherapy with antidepressants for major depressive disorder. However, it has been repeatedly reported that a substantial proportion of patients with schizophrenia or major depressive disorder are treated by psychotropic polypharmacy.

Aims & Objectives
‘the Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)’ project aims to examine the real-world effectiveness of education regarding clinical guidelines for psychiatric disorders. This study examined the relationship between EGUIDE training and treatment behavior with respect to two guidelines (Hasegawa and Yasuda, 2023). If participation in EGUIDE training is found to have an effect on treatment-related behavior, knowledge and attitudes, the guidelines could be implemented nationwide.

Method
The EGUIDE project is a nationwide prospective implementation study of two clinical practice guidelines, i.e., the Guideline for Pharmacological Therapy of Schizophrenia and the Treatment Guidelines for Major Depressive Disorders, in Japan. Between 2016 and 2019, 782 psychiatrists belonging to 176 hospitals with psychiatric wards participated in the project and attended lectures on clinical practice guidelines. The proportions of guideline-recommended treatments in 7405 patients with schizophrenia and 3794 patients with major depressive disorder at participating hospitals were compared between patients under the care of psychiatrists participating in the project and those not participating in the project. Clinical and prescribing data on the patients discharged from April to September each year from participating hospitals of the project were also analyzed.

Results
The proportions of three quality indicators (antipsychotic monotherapy regardless of whether other psychotropics medication, antipsychotic monotherapy without other psychotropics and no prescription of anxiolytics or hypnotics) for schizophrenia were higher among participating psychiatrists than among nonparticipating psychiatrists. As similar results were obtained in major depressive disorder (antidepressant monotherapy without other psychotropics and no prescription of anxiolytics or hypnotics), the effectiveness of the project for the dissemination of guideline-recommended treatment has been replicated.

Discussion & Conclusion
This strategy of providing education regarding the clinical guidelines for psychiatric disorders was effective in improving the treatment-related behavior of psychiatrists. The EGUIDE project has demonstrated the real-world effectiveness in disseminating guidelines for schizophrenia and major depressive disorder in many psychiatric institutions nationwide. The use of this education-based strategy might contribute to resolving the mental health treatment gap.

References
1.Hasegawa N, Yasuda Y, Yasui-Furukori N et al. Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study. Psychiatry Clin Neurosci 2023; 77(10):559-568.