Why should clinical psychologists care about CPGs?

Benefits of CPGs

CPGs have numerous benefits (Hollon, 2014), including:

• Allowing patients to receive care that is informed by the most up-to-date research evidence available, leading to improved outcomes.
• Reducing unjustified variation in treatment and care delivery.
• Assisting patients and healthcare providers in making informed healthcare choices and selecting their preferred choice of intervention based on evidence-based research.
• Influencing future research by highlighting research areas where evidence is lacking in quantity or quality
• Highlighting the most beneficial and well-supported interventions, as well as potentially harmful or wasteful interventions.
• Providing an invaluable summary of literature to busy clinicians who may not have the time to keep up-to-date with the latest and most relevant research

Does the use of CPGs make a difference?

In the medical field, research has shown that implementation of high quality CPGs can clearly improve healthcare outcomes (Wolf, Hubbard, Faraday & Forrest, 2011). Although there aren’t too many outcome studies in the fields of social care and best-practices-psychologychotherapy, some studies have indicated positive outcomes as a result of CPGs implementation. For example, a controlled study conducted by Djik, Verbraak, Oosterbaan, & Balkom (2012) showed that implementing CPGs for anxiety disorders can improve best-practices-psychologychological symptoms. Other naturalistic studies assessing the relationship between receiving guideline-adherent depression treatment and clinical outcomes have also shown a positive relationship indicating improvement in clinical outcomes (Fortney, Rost, Zhang & Pyne, 2001; Melfi, Chawla, Croghan, Hanna, Kennedy, & Sredl, 1998; Revicki, Simon, Chan, Katon, & Heiligenstein, 1998). In addition, a review conducted by Bauer (2002) on CPGs in mental health provides evidence for better health outcomes as a result of adherence to CPGs. However, it also highlights that adherence to CPGs (without any intervention) is generally low, which is why we often see no difference in outcome despite the creation of quality CPGs. In fact, there are some studies showing evidence for the lack of difference in outcome associated with CGPs (e.g., Rost, Zhang, Fortney, Smith, Coyne, & Smith, 1998).

What are some factors that influence the impact of CPGs?

It seems to be that the impact of CPGs on outcome (whether positive or inexistent) varies depending on factors such as the CPGs’ quality, dissemination and utilization (Wolf, Hubbard, Faraday & Forrest, 2011). Some of the specific barriers that can impede positive outcomes of CPGs are: structural (e.g. financial disincentives), organizational (e.g. inappropriate skill mix, lack of facilities or equipment), peer group (e.g. local standards of care not in line with desired practice), professional (e.g. knowledge, attitudes and skills) and professional-patient interaction (e.g. communication and information processing issues) (Grimshaw, Eccles, Lavis, Hill, & Squires, 2012). In order to overcome these barriers and increase the probability of positive outcomes from CPGs, continued efforts should be made towards the standardization of CPG development methods and implementation plans.