背景:在COVID-19大流行期间,牛津精确精神病学实验室(OxPPL)在数字方法和心灵感应等关键领域开发了基于网络的开放式精神卫生保健指南摘要(OxPPL指南),自杀和自我伤害,家庭暴力和虐待,围产期保健,在精神疾病的背景下,疫苗的犹豫和优先考虑,及时告知临床决策。
目的:本研究旨在以OxPPL指南为例,评估在突发卫生事件期间制定循证健康指南的做法。由临床站点和同事组成的国际网络(在澳大利亚,新西兰,和英国),包括临床医生,研究人员,和专家根据经验旨在(1)评估OxPPL指南的临床影响,作为基于证据的指南摘要的一个例子;(2)回顾关于精神保健方面的COVID-19指南的其他基于证据的摘要的文献;(3)制定应对未来全球突发卫生事件的框架.
方法:OxPPL指南的影响和临床效用通过国际调查和焦点小组使用临床医生的反馈进行评估。一项系统评价(在开放科学框架上注册的方案)确定了COVID-19大流行期间和之后的精神卫生保健指南的摘要或综合,并通过确定该指南未包括的任何资源来评估OxPPL指南中使用的方法的准确性。
结果:总体而言,80.2%(146/182)的临床医生同意或强烈同意OxPPL指南回答了重要的临床问题。73.1%(133/182)表示指南与他们的服务相关,59.3%(108/182)的人说,指南已经或将对他们的临床实践产生积极影响,42.9%(78/182)表示他们已经分享或将分享指导,80.2%(146/182)表示该方法可用于未来的健康危机。焦点小组发现,基于证据的知识的组合,临床观点,可见性对临床实施至关重要.系统审查确定了2543条记录,其中2份准则综合符合所有纳入标准,但只有1个(OxPPL指南)使用了循证方法。审查显示,OxPPL指南包含了大多数合格的指南,但有6人被确定为未包括在内。
结论:该研究确定了基于网络的未满足需求,COVID-19大流行期间的循证精神卫生保健指导。临床医生评估OxPPL指导具有现实世界的临床影响。强有力的循证方法和心理健康专业知识是必要的,但也需要容易获得,数字技术可以提供实质性帮助。进一步的卫生紧急情况是不可避免的,现在是准备的理想时机,包括解决临床医生的培训需求,病人,和照顾者,特别是在心灵感应和数字心理健康等领域。为了未来的规划,指南应在国际平台上广泛传播,具有分配的资源以支持自适应更新。
BACKGROUND: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making.
OBJECTIVE: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2)
review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies.
METHODS: The impact and clinical utility of the OxPPL guidance were assessed using clinicians\' feedback via an international survey and focus groups. A systematic
review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included.
RESULTS: Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic
review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The
review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included.
CONCLUSIONS: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates.