Implementation of Guidelines on Prevention of Coercion and Violence (PreVCo) in Psychiatry: Study Protocol of a Randomized Controlled Trial (RCT).
clinical guidelines
coercive measures
evidence based treatment
psychiatry
quality management
restraint
seclusion
violence
Journal
Frontiers in psychiatry
ISSN: 1664-0640
Titre abrégé: Front Psychiatry
Pays: Switzerland
ID NLM: 101545006
Informations de publication
Date de publication:
2020
2020
Historique:
received:
01
07
2020
accepted:
28
08
2020
entrez:
26
10
2020
pubmed:
27
10
2020
medline:
27
10
2020
Statut:
epublish
Résumé
Coercive measures are among the most controversial interventions in psychiatry. There is a large discrepancy between the sheer number of high-quality guidelines and the small number of scientifically accompanied initiatives to promote and evaluate their implementation into clinical routine. In Germany, an expert group developed guidelines to provide evidence- and consensus-based recommendations on how to deal with violence and coercion in psychiatry. The study presented examines whether coercive measures on psychiatric wards can be reduced by means of an operationalized implementation of the guidelines "Prevention of coercion: prevention and therapy of aggressive behavior in adults". Out of a set of 12 interventions offered, wards are free to choose three interventions they want to implement. The primary outcome is the number of coercive measures per bed and month/year. Secondary outcomes are cumulative duration of coercive measures per bed and month/year. The most important control variable is the number of aggressive incidents. We plan to recruit 52 wards in Germany. Wards treating both voluntary and compulsorily admitted patients will be included. A 1:1 stratified randomized controlled trial will be conducted stratified by the amount of coercive measures and implemented aspects of the guidelines. In addition to the control group analysis, a waiting list design allows a pre-post analysis for all participating wards of the waiting list group. A parallel qualitative study will examine factors related to successful implementation and to successful reduction of coercion as well as relevant barriers. We are planning a nationwide study on the implementation of evidence- and consensus-based guidelines in psychiatric hospitals. This study intends to promote the transfer of expert knowledge as well as results from clinical trials into clinical routine with the potential to change supply structures in mental health sector. www.isrctn.com, identifier ISRCTN71467851.
Sections du résumé
BACKGROUND
BACKGROUND
Coercive measures are among the most controversial interventions in psychiatry. There is a large discrepancy between the sheer number of high-quality guidelines and the small number of scientifically accompanied initiatives to promote and evaluate their implementation into clinical routine. In Germany, an expert group developed guidelines to provide evidence- and consensus-based recommendations on how to deal with violence and coercion in psychiatry.
METHODS
METHODS
The study presented examines whether coercive measures on psychiatric wards can be reduced by means of an operationalized implementation of the guidelines "Prevention of coercion: prevention and therapy of aggressive behavior in adults". Out of a set of 12 interventions offered, wards are free to choose three interventions they want to implement. The primary outcome is the number of coercive measures per bed and month/year. Secondary outcomes are cumulative duration of coercive measures per bed and month/year. The most important control variable is the number of aggressive incidents. We plan to recruit 52 wards in Germany. Wards treating both voluntary and compulsorily admitted patients will be included. A 1:1 stratified randomized controlled trial will be conducted stratified by the amount of coercive measures and implemented aspects of the guidelines. In addition to the control group analysis, a waiting list design allows a pre-post analysis for all participating wards of the waiting list group. A parallel qualitative study will examine factors related to successful implementation and to successful reduction of coercion as well as relevant barriers.
DISCUSSION
CONCLUSIONS
We are planning a nationwide study on the implementation of evidence- and consensus-based guidelines in psychiatric hospitals. This study intends to promote the transfer of expert knowledge as well as results from clinical trials into clinical routine with the potential to change supply structures in mental health sector.
CLINICAL TRIAL REGISTRATION
BACKGROUND
www.isrctn.com, identifier ISRCTN71467851.
Identifiants
pubmed: 33101091
doi: 10.3389/fpsyt.2020.579176
pmc: PMC7522201
doi:
Types de publication
Journal Article
Langues
eng
Pagination
579176Informations de copyright
Copyright © 2020 Steinert, Bechdolf, Mahler, Muche, Baumgardt, Bühling-Schindowski, Cole, Kampmann, Sauter, Vandamme, Weinmann and Hirsch.
Références
Soc Psychiatry Psychiatr Epidemiol. 2015 Dec;50(12):1857-69
pubmed: 26188503
Int J Ment Health Syst. 2016 Feb 17;10:7
pubmed: 26893609
Psychiatr Prax. 2019 Mar;46(2):82-89
pubmed: 30149398
J Am Med Dir Assoc. 2013 Sep;14(9):690-5
pubmed: 23827658
Lancet. 2013 May 11;381(9878):1634-41
pubmed: 23537606
Soc Psychiatry Psychiatr Epidemiol. 2007 Feb;42(2):140-5
pubmed: 17180296
BJPsych Open. 2019 Jun 13;5(4):e53
pubmed: 31530302
J Clin Psychiatry. 2008 Aug;69(8):1299-306
pubmed: 18642975
BMC Health Serv Res. 2016 Aug 11;16(a):372
pubmed: 27514778
BJPsych Int. 2017 Aug 01;14(3):61-63
pubmed: 29093947
Community Ment Health J. 2016 Nov;52(8):1033-1036
pubmed: 25535054
Soc Psychiatry Psychiatr Epidemiol. 2016 Sep;51(9):1301-9
pubmed: 27147243
Issues Ment Health Nurs. 2020 Aug 4;:1-7
pubmed: 32749904
Int J Nurs Stud. 2015 Sep;52(9):1412-22
pubmed: 26166187
Front Psychiatry. 2019 May 24;10:340
pubmed: 31178766
Psychiatr Serv. 2013 Sep 1;64(9):850-5
pubmed: 23771480
Br J Psychiatry. 2008 Jul;193(1):44-50
pubmed: 18700217
Nervenarzt. 2019 Jan;90(1):35-39
pubmed: 30215134
Acta Psychiatr Scand Suppl. 2002;(412):101-2
pubmed: 12072137
Nervenarzt. 2014 Nov;85(11):1419-31
pubmed: 25388831
Psychiatr Prax. 2015 Oct;42(7):377-83
pubmed: 25068687
Eur Arch Psychiatry Clin Neurosci. 2010 Feb;260(1):51-7
pubmed: 19876665
Lancet. 2014 Nov 1;384(9954):1573-4
pubmed: 25443484
Psychiatr Prax. 2020 Jul;47(5):242-248
pubmed: 32198733
Nervenarzt. 2016 Jan;87(1):1-3
pubmed: 26666767
Int J Environ Res Public Health. 2018 May 03;15(5):
pubmed: 29751572
Br J Psychiatry. 2017 Jan;210(1):24-30
pubmed: 27445353