THE VALUE OF EVIDENCE-BASED GUIDELINES IN BRIDGING THE GAP BETWEEN RESEARCH AND PRACTICE: FROM THE DEVELOPMENT OF GRADE RECOMMENDATIONS TO THE EVALUATION OF THEIR IMPLEMENTABILITY A project of knowledge translation in the Verona Department of Mental Health

Title The value of evidence-based guidelines in bridging the gap between research and practice: from the development of GRADE recommendations to the evaluation of their implementability. A project of knowledge translation in the Verona Department of Mental Health. Background Research evidence alone cannot determine clinical strategies, but when integrated with patients’ clinical needs and wishes, it provides a fundamental input for producing meaningful decisions about treatment management and quality improvement. This is in line with the principles of evidence-based medicine. However, access and use of research findings may not be straightforward for most doctors, and this may determine a failure in the process of translating research findings into practice. This failure has often been described as a gap between evidence and practice, with negative consequences for patients who may not benefit optimally from advances in healthcare. In order to fill this gap, the development of evidence-based treatment guidelines has been suggested as a valuable link between primary research and daily clinical practice. One of the best developed approaches for aggregating, synthesizing and grading the quality of evidence extracted from systematic reviews is the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Objectives I) To develop a set of evidence-based guidelines which may bring research findings into clinical practice; II) To build up a shared strong methodology for choosing and managing pharmacological treatments in the context of the Verona Department of Mental Health; III) To assess guideline impact on clinical practice. Methods A Guideline Development Group (GDG), including representatives of the four Mental Health Services of the Verona Department of Mental Health (DMH), was created. The GDG developed recommendations supported by the Unit of Clinical Psychopharmacology of the University of Verona. After identification of the most problematic clinical situations where recommendations in the field of psychotropic drugs were thought to be needed, the GDG reviewed all available evidence for each topic, and the Scientific Committee summarized the evidence base using the GRADE methodology for the production of recommendations sustained by evidence of efficacy. For each question, values, preferences, and feasibility considerations relating to the local context were also taken into account. Draft recommendations were presented and discussed in two plenary sessions with all medical staff of the DMH in order to reach a consensus and a formal agreement. After that, recommendations were distributed to all clinicians of the DMH, with the request of taking them into consideration in their routine clinical practice. As final step, some indicators were identified to monitor the degree of coherence between what the guidelines report and what is actually done. Results Recommendations were formulated on 12 topics. The results of the evaluation phase showed that after the dissemination of guidelines the use of medicines in the DMH follows a trend that is consistent with the content of their content for some recommendations, but not for others. Conclusions This project of guidelines development included several peculiar aspects, such as a bottom-up approach; this means that physicians were involved since the very initial steps of guideline production, starting from the choice of topics on which formulate recommendations. A methodologically sound procedure, from the phases of guidelines choice and production, to the one of their dissemination and evaluation, was conceptualized and structured. To our knowledge, not many examples of such a methodology are available in the literature.