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Clinical pathways in psychiatry

Evans-Lacko, Sara, Jarrett, Manuela, McCrone, Paul and Thornicroft, Graham (2008) Clinical pathways in psychiatry. British Journal of Psychiatry, 193 (1). pp. 4-5. ISSN 0007-1250

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Identification Number: 10.1192/bjp.bp.107.048926

Abstract

This editorial summarises the literature on the use of care pathways in psychiatry. Further, it considers the case-mix clusters used in care pathways in relation to health service financial tariff and currency systems, and also reviews the evidence for the effectiveness of clinical pathways. Increasing emphasis is being placed on the implementation of care pathways for mental health, both nationally and internationally. Several clinical pathways have already been implemented in all types of healthcare settings, including psychiatry, both in the UK1 and abroad.2 Although many different definitions have been developed for care pathways, most include at least two specific components: (a) the types of services/interventions that are provided (e.g. assessment, admission, therapy); and (b) the time line over which this happens. For example, a definition used within the UK National Health Service (NHS) states that care pathways are: “‘both a tool and a concept that embed guidelines, protocols and locally agreed, evidence-based, patient-centred, best practice, into everyday use for the individual patient. In addition, and uniquely to ICPs [integrated care pathways], they record deviations from planned care in the form of variances.’1” Care pathway development began in the USA during the 1980s within managed care. Interest in care pathways then emerged in the UK during the early 1990s, along with the implementation of pilot sites. Despite growing enthusiasm for care pathways, evidence to support their effectiveness is, at present, weak. Their use is predicated on the hypothesis that the implementation of care pathways will help to improve care, for example by reducing the length of stay, improving multidisciplinary collaboration, increasing evidence-based practice, containing costs, or by enhancing patient empowerment.3–5 There is, however, limited evidence supporting any of these outcomes.4,6 Several studies have examined the effectiveness of care pathways; however, a review of the quality of these studies demonstrates poor overall scientific quality.7 Specifically, several studies are flawed by use of historical controls without adequate adjustment for secular trends. Comprehensive reviews of care pathways in general medical and surgical settings also show weak evidence for reducing length of stay or improving care.6

Item Type: Article
Official URL: http://bjp.rcpsych.org/
Additional Information: © 2008 Royal College of Psychiatrists
Divisions: Personal Social Services Research Unit
Subjects: R Medicine > RC Internal medicine
Sets: Research centres and groups > Personal Social Services Research Unit (PSSRU)
Date Deposited: 10 Aug 2015 11:06
Last Modified: 20 May 2020 01:59
URI: http://eprints.lse.ac.uk/id/eprint/63045

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