Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study
IntroductionThe PreVCo study examines whether a structured, operationalized implementation of guidelines to prevent coercion actually leads to fewer coercive measures on psychiatric wards. It is known from the literature that rates of coercive measures differ greatly between hospitals within a count...
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1130727/full |
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| author | Sophie Hirsch Sophie Hirsch Johanna Baumgardt Johanna Baumgardt Andreas Bechdolf Andreas Bechdolf Felix Bühling-Schindowski Celline Cole Erich Flammer Lieselotte Mahler Lieselotte Mahler Rainer Muche Dorothea Sauter Angelika Vandamme PreVCo Study Group Tilman Steinert |
| author_facet | Sophie Hirsch Sophie Hirsch Johanna Baumgardt Johanna Baumgardt Andreas Bechdolf Andreas Bechdolf Felix Bühling-Schindowski Celline Cole Erich Flammer Lieselotte Mahler Lieselotte Mahler Rainer Muche Dorothea Sauter Angelika Vandamme PreVCo Study Group Tilman Steinert |
| author_sort | Sophie Hirsch |
| collection | DOAJ |
| description | IntroductionThe PreVCo study examines whether a structured, operationalized implementation of guidelines to prevent coercion actually leads to fewer coercive measures on psychiatric wards. It is known from the literature that rates of coercive measures differ greatly between hospitals within a country. Studies on that topic also showed large Hawthorne effects. Therefore, it is important to collect valid baseline data for the comparison of similar wards and controlling for observer effects.MethodsFifty five psychiatric wards in Germany treating voluntary and involuntary patients were randomly allocated to an intervention or a waiting list condition in matched pairs. As part of the randomized controlled trial, they completed a baseline survey. We collected data on admissions, occupied beds, involuntarily admitted cases, main diagnoses, the number and duration of coercive measures, assaults and staffing levels. We applied the PreVCo Rating Tool for each ward. The PreVCo Rating Tool is a fidelity rating, measuring the degree of implementation of 12 guideline-linked recommendations on Likert scales with a range of 0–135 points covering the main elements of the guidelines. Aggregated data on the ward level is provided, with no patient data provided. We performed a Wilcoxon signed-rank-test to compare intervention group and waiting list control group at baseline and to assess the success of randomization.ResultsThe participating wards had an average of 19.9% involuntarily admitted cases and a median 19 coercive measures per month (1 coercive measure per occupied bed, 0.5 per admission). The intervention group and waiting list group were not significantly different in these measurements. There were 6.0 assaults per month on average (0.3 assaults per occupied bed and 0.1 per admission). The PreVCo Rating Tool for guideline fidelity varied between 28 and 106 points. The percentage of involuntarily admitted cases showed a correlation with coercive measures per month and bed (Spearman’s Rho = 0.56, p < 0.01).DiscussionOur findings that coercion varies widely within a country and mainly is associated with involuntarily admitted and aggressive patients are in line with the international literature. We believe that we included a sample that covers the scope of mental health care practice in Germany well.Clinical trial registration: www.isrctn.com, identifier ISRCTN71467851. |
| first_indexed | 2024-04-09T13:11:20Z |
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| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-04-09T13:11:20Z |
| publishDate | 2023-05-01 |
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| series | Frontiers in Psychiatry |
| spelling | doaj.art-7ef7ef9c334b43f28fad4b0e75bae4992023-05-12T07:08:15ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-05-011410.3389/fpsyt.2023.11307271130727Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo studySophie Hirsch0Sophie Hirsch1Johanna Baumgardt2Johanna Baumgardt3Andreas Bechdolf4Andreas Bechdolf5Felix Bühling-Schindowski6Celline Cole7Erich Flammer8Lieselotte Mahler9Lieselotte Mahler10Rainer Muche11Dorothea Sauter12Angelika Vandamme13PreVCo Study GroupTilman Steinert14Department for Psychiatry and Psychotherapy I, Faculty of Medicine, Ulm University, Ulm, GermanyDepartment for Psychiatry and Psychotherapy Biberach, ZfP Südwürttemberg, Biberach, GermanyDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban, Berlin, GermanyResearch Institute of the Local Health Care Funds (WIdO), Berlin, GermanyDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban, Berlin, GermanyDepartment of Psychiatry and Psychotherapy, Charité Univesitätsmedizin, Berlin, GermanyDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban, Berlin, GermanyDepartment of Psychiatry and Psychotherapy, Charité Univesitätsmedizin, Berlin, GermanyDepartment for Psychiatry and Psychotherapy I, Faculty of Medicine, Ulm University, Ulm, GermanyDepartment of Psychiatry and Psychotherapy, Charité Univesitätsmedizin, Berlin, GermanyDepartment of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Berlin, GermanyFaculty of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, GermanyDepartment for Psychiatry and Psychotherapy I, Faculty of Medicine, Ulm University, Ulm, GermanyDepartment of Psychiatry and Psychotherapy, Charité Univesitätsmedizin, Berlin, GermanyDepartment for Psychiatry and Psychotherapy I, Faculty of Medicine, Ulm University, Ulm, GermanyIntroductionThe PreVCo study examines whether a structured, operationalized implementation of guidelines to prevent coercion actually leads to fewer coercive measures on psychiatric wards. It is known from the literature that rates of coercive measures differ greatly between hospitals within a country. Studies on that topic also showed large Hawthorne effects. Therefore, it is important to collect valid baseline data for the comparison of similar wards and controlling for observer effects.MethodsFifty five psychiatric wards in Germany treating voluntary and involuntary patients were randomly allocated to an intervention or a waiting list condition in matched pairs. As part of the randomized controlled trial, they completed a baseline survey. We collected data on admissions, occupied beds, involuntarily admitted cases, main diagnoses, the number and duration of coercive measures, assaults and staffing levels. We applied the PreVCo Rating Tool for each ward. The PreVCo Rating Tool is a fidelity rating, measuring the degree of implementation of 12 guideline-linked recommendations on Likert scales with a range of 0–135 points covering the main elements of the guidelines. Aggregated data on the ward level is provided, with no patient data provided. We performed a Wilcoxon signed-rank-test to compare intervention group and waiting list control group at baseline and to assess the success of randomization.ResultsThe participating wards had an average of 19.9% involuntarily admitted cases and a median 19 coercive measures per month (1 coercive measure per occupied bed, 0.5 per admission). The intervention group and waiting list group were not significantly different in these measurements. There were 6.0 assaults per month on average (0.3 assaults per occupied bed and 0.1 per admission). The PreVCo Rating Tool for guideline fidelity varied between 28 and 106 points. The percentage of involuntarily admitted cases showed a correlation with coercive measures per month and bed (Spearman’s Rho = 0.56, p < 0.01).DiscussionOur findings that coercion varies widely within a country and mainly is associated with involuntarily admitted and aggressive patients are in line with the international literature. We believe that we included a sample that covers the scope of mental health care practice in Germany well.Clinical trial registration: www.isrctn.com, identifier ISRCTN71467851.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1130727/fullpsychiatryseclusionrestraintguidelinesevidence based careimplementation |
| spellingShingle | Sophie Hirsch Sophie Hirsch Johanna Baumgardt Johanna Baumgardt Andreas Bechdolf Andreas Bechdolf Felix Bühling-Schindowski Celline Cole Erich Flammer Lieselotte Mahler Lieselotte Mahler Rainer Muche Dorothea Sauter Angelika Vandamme PreVCo Study Group Tilman Steinert Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study Frontiers in Psychiatry psychiatry seclusion restraint guidelines evidence based care implementation |
| title | Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study |
| title_full | Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study |
| title_fullStr | Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study |
| title_full_unstemmed | Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study |
| title_short | Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study |
| title_sort | implementation of guidelines on prevention of coercion and violence baseline data of the randomized controlled prevco study |
| topic | psychiatry seclusion restraint guidelines evidence based care implementation |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1130727/full |
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