Saturday, May 5, 2012

Practice Guidelines Pose Practical Problems

Clinical practice guidelines can help clinicians provide better care by evaluating the best available research. However, putting guidelines to use in day-to-day practice isn’t easy, said experts on managing posttraumatic stress disorder in military populations. They were speaking at APA's 2012 annual meeting in Philadelphia.

For one thing, there are several sets of guidelines, issued by different organizations, and they don’t always agree, said Army Col. David Benedek, M.C., a professor and deputy chair of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md. Most of those guidelines lumped together clinical trials of civilian and military populations.

“Overall, there’s poor evidence for the value of SSRIs but there’s good evidence that they help people with non-combat PTSD,” said Benedek.

Once guidelines have been selected, it’s necessary to get them into the hands of clinicians. The Department of Veterans Affairs and the Department of Defense issued combined guidelines in 2010 and 2011. Air Force psychiatrist Lt. Col. Charles Motsinger, M.D., is part of a group working to modify the military electronic health records system and bring them to the point of care in the primary care setting.

The first part of their approach uses office staff to screen patients when they check in. That information goes into the health record and is immediately available to the physician on a computer in the examining room. The physician can then ask more detailed, less structured questions in narrative form. The computer program also provides recommendations for treatment and follow-up, and the physician can add elaborated narrative observations and recommendations for care.

Pilot versions of this new approach are being tested now at Ft. Belvoir, Va., and will be implemented soon in Air Force medical settings.

(Image: Konstantin Sutyagin


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