Adherence to Guidelines and Treatment Compliance in the Chilean National Program for First-Episode Schizophrenia

Objective:

Adherence to clinical guidelines for mental disorders among clinicians in industrialized countries is low. Research on guideline adherence among clinicians in lower- and middle-income countries is scarce. The purpose of this study was to evaluate the implementation of clinical guidelines for first-episode schizophrenia in the pilot phase of the Explicit Guarantees in Health (GES) program in Chile.

Methods:

Data were collected from 12 catchment areas in Chile, representing 58% of the public health system. Records for 20 patients from each site who were referred to the GES program with a tentative diagnosis of first-episode schizophrenia were reviewed. Adherence to first- and second-line antipsychotic treatments, use of diagnostic measures, and psychosocial interventions recommended in the guidelines were evaluated.

Results:

In the final sample of 110 patients, adherence to medication guidelines was good—86% received the recommended first-line antipsychotic. Psychoeducation was provided to 55% of patients and 49% of their families, but other psychosocial interventions were used more rarely. Use of symptom rating scales was low. At 12 months, 19% of patients had dropped out of treatment.

Conclusions:

Adherence to treatment guidelines in the Chilean GES program was remarkably good for pharmacological treatment, average for psychosocial interventions, and low for utilization of symptom scales and diagnostic measures. The dropout rate was low. (Psychiatric Services 62:1463–1469, 2011)