Magazine article Clinical Psychiatry News

Algorithmic Psychiatry

Magazine article Clinical Psychiatry News

Algorithmic Psychiatry

Article excerpt

Algorithms are nothing new to medicine.

When the Agency for Health Care Policy and Research (AHCPR) was established within the U.S. Department of Health and Human Services in 1989, depression was one of the first of seven problem areas selected for guideline development for primary care. It neared the top of the list for the following reasons:

* Most depressed patients seek care from primary care physicians.

* A wide range of treatments is available.

* There is a large body of relevant scientific evidence available on how to diagnose and treat depression and, therefore, to develop guidelines.

* Practice surveys suggest that improved detection and treatment could improve clinical outcomes.

* The disability and mortality associated with depression are enormous.

Similar efforts to develop practice guidelines for the treatment of depression were launched by other medical groups--in particular the American Psychiatric Association in 1993 (revised in 2000).

Evidence-based medicine with guideline-driven care is inevitable for psychiatry. The important question is this: How will this approach affect our practices?

A major aim of the practice guideline is to limit the unnecessarily wide variations in treatment approaches between many practitioners treating the same condition. This is expected to improve the quality of care, which, in turn, should improve clinical outcomes. Whether the use of such guidelines in everyday practice actually improves outcomes has only recently been evaluated.

A University of Washington study utilizing the AHCPR depression guideline in a primary care setting was the first to evaluate guidelines for any mental illness (JAMA 273[13]:1026-31, 1995). Results revealed improvement in outcomes, but not without increased costs.

At the American Psychiatric Association's 2001 annual meeting in New Orleans, two studies reported better clinical outcomes with guideline care than with the use of treatment as usual:

* A German psychiatric inpatient study by M. Bauer and associates.

* The Texas Medical Algorithm Project (TMAP), which examined findings in psychiatric practice in the public sector.

Evidence to date indicates that disseminating and implementing available information to recommend preferred diagnostic and treatment practices appear to improve the quality of care and clinical outcomes. …

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