Practice guidelines are intended to assist providers and consumers in clinical decision-making and to improve care. They also document evidence available to determine appropriate care. Guidelines are not meant to dictate clinical practice but are evidenced based and a good place to go for guidance in the care of mental disorders. One needs to keep in mind that each patient is an individual and that each provider has his or her own approach to delivery of care. Therefore, all treatment must be individualized to the patient. Good clinical judgment should be used in all situations and at times will supersede practice guidelines.
Piedmont will use practice guidelines and clinical standards to evaluate effectiveness and appropriateness of care. The utilization management unit performs this function. Care that is deemed outside the norm will be evaluated by these guidelines. Providers may also use these guidelines as a road map for effective evidence based care. We also intend consumers to use these guidelines to help them make decisions about treatment.
Good examples of the use of guidelines are the following:
- A provider is treating a patient who suffers from schizophrenia who is still psychotic after a trial of 3 antipsychotics. The guidelines clearly show that the next step is for the patient to be placed on Clozaril. The provider should make arrangements for the patient to receive Clozaril. If the case were reviewed by UR, we would require that the patient be placed on Clozaril if there were no contraindications and the patient was willing.
- A patient with depression is being treated with Cognitive Behavioral Therapy (CBT). The patient is not sure if this is a valid treatment for this illness. The guidelines do recommend CBT for the treatment of depression. They would also notice that medication is recommended for depression. This would allow for the patient to make an informed decision about their care.
Many of these guidelines have been adopted from the American Psychiatric Association. Piedmont staff and consultants who are considered experts in their fields have developed several of these guidelines where national guidelines were not available. All of the guidelines have been reviewed and accepted by our Clinical Advisory Council that consists of staff, practitioners, and consumers.
Please use these guidelines as a road map and an educational tool. They are best used when patients are not achieving improvement goals.
Piedmont will continue to monitor, revise, and add to this list of guidelines.
Craig B. Hummel, M.D.
Medical Director
PBH
