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Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales.

Morriss R - BMC Med (2015)

Bottom Line: Most governments, including those of England and Wales, need to improve healthcare but at reduced cost.There is no mechanism to ensure that healthcare professionals know or consider them.Mitigation to these barriers is presented herein.

View Article: PubMed Central - PubMed

Affiliation: Psychiatry and Community Mental Health, University of Nottingham, Nottingham, UK. richard.morriss@nottingham.ac.uk.

ABSTRACT

Background: Bipolar disorder is a common long-term mental health condition characterised by episodes of mania or hypomania and depression resulting in disability, early death, and high health and society costs. Public money funds the National Institute of Healthcare and Clinical Excellence (NICE) to produce clinical guidelines by systematically identifying the most up to date research evidence and costing its main recommendations for healthcare organisations and professionals to follow in England and Wales. Most governments, including those of England and Wales, need to improve healthcare but at reduced cost. There is evidence, particularly in bipolar disorder, that systematically following clinical guidelines achieves these outcomes.

Discussion: NICE clinical guidelines, including those regarding bipolar disorder, remain variably implemented. They give clinicians and patients a non-prescriptive basis for deciding their care. Despite the passing of the Health and Social Care Act in 2012 in England requiring all healthcare organisations to consider NICE clinical guidelines in commissioning, delivering, and inspecting healthcare services, healthcare organisations in the National Health Service may ignore them with little accountability and few consequences. There is no mechanism to ensure that healthcare professionals know or consider them. Barriers to their implementation include the lack of political and professional leadership, the complexity of the organisation of care and policy, mistrust of some processes and recommendations of clinical guidelines, and a lack of a clear implementation model, strategy, responsibility, or accountability. Mitigation to these barriers is presented herein.

Summary: The variability, safety, and quality of healthcare might be improved and its cost reduced if the implementation of NICE clinical guidelines, such as those for bipolar disorder, were made the minimum starting point for clinical decision-making and mandatory responsibilities of all healthcare organisations and professionals.

No MeSH data available.


Related in: MedlinePlus

Relationships of NICE to National Health Services and Workforce organisations under Health and Social Act (2012). Indirect relationships Direct relationships. Does not fully represent all social care, public health, third sector, and independent contractors. England only. Wales is not represented
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Fig1: Relationships of NICE to National Health Services and Workforce organisations under Health and Social Act (2012). Indirect relationships Direct relationships. Does not fully represent all social care, public health, third sector, and independent contractors. England only. Wales is not represented

Mentions: Box 2 summarises the potential benefits of the mandatory implementation of NICE clinical guidelines. Legislation was passed to promote the consideration of NICE clinical guidelines for health conditions by all NHS organisations in England under the Health and Social Care Act (2012) [11], and set up a number of other bodies such as Academic Health Science Networks and strategic clinical networks to help implement evidence-based care and innovation, including NICE clinical guidelines, into practice (Fig. 1). NICE clinical guidelines are best considered as a starting point for clinical care and are not designed to cover every clinical situation that may arise, so health professionals and NHS organisations must use their judgement to optimise clinical care for each patient they see [12]; these may be useful in other countries who wish to adopt the approach [13, 14]. Like most NICE clinical guidelines, the 2006 NICE Clinical Guideline for Bipolar Disorder [15] seems to have been incompletely and variably implemented [16]. For instance, the 2006 NICE Clinical Guideline for Bipolar Disorder recommendations concerning lithium monitoring were followed in 48–70 % patients in a recent national audit [17], while counselling about teratogenic risk and contraception in women of childbearing age taking anticonvulsants was only 22 % [18]. There is great variation in the implementation of NICE guidelines not only between organisations but also within the same organisation over time [19, 20]. In particular, NICE recommendations that require changes in the organisation of care or are conflicting to established practice are poorly implemented [16]. A more standardised and systematic approach to care as outlined by the NICE clinical guideline that is still patient centred should reduce one source of variability of outcome in patients with bipolar disorder, a condition with a highly variable outcome due to its natural history.Fig. 1


Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales.

Morriss R - BMC Med (2015)

Relationships of NICE to National Health Services and Workforce organisations under Health and Social Act (2012). Indirect relationships Direct relationships. Does not fully represent all social care, public health, third sector, and independent contractors. England only. Wales is not represented
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4588679&req=5

Fig1: Relationships of NICE to National Health Services and Workforce organisations under Health and Social Act (2012). Indirect relationships Direct relationships. Does not fully represent all social care, public health, third sector, and independent contractors. England only. Wales is not represented
Mentions: Box 2 summarises the potential benefits of the mandatory implementation of NICE clinical guidelines. Legislation was passed to promote the consideration of NICE clinical guidelines for health conditions by all NHS organisations in England under the Health and Social Care Act (2012) [11], and set up a number of other bodies such as Academic Health Science Networks and strategic clinical networks to help implement evidence-based care and innovation, including NICE clinical guidelines, into practice (Fig. 1). NICE clinical guidelines are best considered as a starting point for clinical care and are not designed to cover every clinical situation that may arise, so health professionals and NHS organisations must use their judgement to optimise clinical care for each patient they see [12]; these may be useful in other countries who wish to adopt the approach [13, 14]. Like most NICE clinical guidelines, the 2006 NICE Clinical Guideline for Bipolar Disorder [15] seems to have been incompletely and variably implemented [16]. For instance, the 2006 NICE Clinical Guideline for Bipolar Disorder recommendations concerning lithium monitoring were followed in 48–70 % patients in a recent national audit [17], while counselling about teratogenic risk and contraception in women of childbearing age taking anticonvulsants was only 22 % [18]. There is great variation in the implementation of NICE guidelines not only between organisations but also within the same organisation over time [19, 20]. In particular, NICE recommendations that require changes in the organisation of care or are conflicting to established practice are poorly implemented [16]. A more standardised and systematic approach to care as outlined by the NICE clinical guideline that is still patient centred should reduce one source of variability of outcome in patients with bipolar disorder, a condition with a highly variable outcome due to its natural history.Fig. 1

Bottom Line: Most governments, including those of England and Wales, need to improve healthcare but at reduced cost.There is no mechanism to ensure that healthcare professionals know or consider them.Mitigation to these barriers is presented herein.

View Article: PubMed Central - PubMed

Affiliation: Psychiatry and Community Mental Health, University of Nottingham, Nottingham, UK. richard.morriss@nottingham.ac.uk.

ABSTRACT

Background: Bipolar disorder is a common long-term mental health condition characterised by episodes of mania or hypomania and depression resulting in disability, early death, and high health and society costs. Public money funds the National Institute of Healthcare and Clinical Excellence (NICE) to produce clinical guidelines by systematically identifying the most up to date research evidence and costing its main recommendations for healthcare organisations and professionals to follow in England and Wales. Most governments, including those of England and Wales, need to improve healthcare but at reduced cost. There is evidence, particularly in bipolar disorder, that systematically following clinical guidelines achieves these outcomes.

Discussion: NICE clinical guidelines, including those regarding bipolar disorder, remain variably implemented. They give clinicians and patients a non-prescriptive basis for deciding their care. Despite the passing of the Health and Social Care Act in 2012 in England requiring all healthcare organisations to consider NICE clinical guidelines in commissioning, delivering, and inspecting healthcare services, healthcare organisations in the National Health Service may ignore them with little accountability and few consequences. There is no mechanism to ensure that healthcare professionals know or consider them. Barriers to their implementation include the lack of political and professional leadership, the complexity of the organisation of care and policy, mistrust of some processes and recommendations of clinical guidelines, and a lack of a clear implementation model, strategy, responsibility, or accountability. Mitigation to these barriers is presented herein.

Summary: The variability, safety, and quality of healthcare might be improved and its cost reduced if the implementation of NICE clinical guidelines, such as those for bipolar disorder, were made the minimum starting point for clinical decision-making and mandatory responsibilities of all healthcare organisations and professionals.

No MeSH data available.


Related in: MedlinePlus