Evaluation of a schizophrenia medication algorithm in a state hospital.

Provider's practice behaviors before and after physician and staff training in the use of a schizophrenia medication algorithm and the effects of education on physician adherence to the algorithm were evaluated. Medical records of 30 patients admitted between September 1 and November 30, 1999, and 3...

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Publicado en:American Journal of Health-System Pharmacy Vol. 60; no. 14; pp. 1459 - 1468
Autores principales: Chuang W, Crismon ML
Formato: algorithm research tables/charts Journal Article
Publicado: Oxford University Press / USA 7/15/2003
Acceso en línea:Ver este registro en EBSCOhost
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        atl: Evaluation of a schizophrenia medication algorithm in a state hospital.
      aug:
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          Chuang W
          Crismon ML
        affil: Pharmacy Practice Resident, Scott and White Medical Center, Temple, TX
      sug:
        subj:
          Algorithms Evaluation
          Schizophrenia Drug Therapy
          Adult
          Antipsychotic Agents Administration and Dosage
          Chi Square Test
          Clinical Research
          Descriptive Research
          Descriptive Statistics
          Female
          Hospitals, Psychiatric
          Male
          Medical Records
          Middle Age
          Random Sample
          Record Review
          Schizophrenia Symptoms
          Staff Development
          T-Tests
          Texas
          Treatment Outcomes Evaluation
          Two-Tailed Test
          Funding Source
          Human
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Female
          Male
      ab: Provider's practice behaviors before and after physician and staff training in the use of a schizophrenia medication algorithm and the effects of education on physician adherence to the algorithm were evaluated. Medical records of 30 patients admitted between September 1 and November 30, 1999, and 30 patients admitted from September 1 to November 30, 2000, with an admitting and discharge diagnosis of schizophrenia and a minimum length of stay of 14 days were randomly selected and analyzed. Clinical data, including prescribed psychotropic medications and dosages, documentation of target symptoms and severity, adverse drug effects, appropriate clinical ratings, patient's response to treatment, and reason for medication change, were collected and compared with the recommendations in the schizophrenia medication algorithm. Efforts to implement the schizophrenia algorithm included staff education and uniform documentation. Progress notes were evaluated before and after training. After physician and staff training, only 5 of 359 progress notes were written using the recommended documentation form. The number of progress notes containing no documentation of symptoms decreased from 66 to 41, and those documenting three to five target symptoms increased from 74 to 140. Documentation of physician assessment of the presence or absence of adverse effects and their severity decreased from 35.2% to 18.7% and from 22.3% to 17.0%, respectively. Physicians increased the documentation of their clinical global impressions from 12.1% to 20.3%. The recording of medication changes increased twofold, but the difference was not significant. Physician and staff education alone did not significantly alter providers' practice behavior. Inadequate and inconsistent documentation of clinical outcomes made it difficult to assess physician adherence to the treatment algorithm.
      pubtype: Academic Journal
      doctype:
        algorithm
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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