Psychosocial Interventions for Mental and Substance Use Disorders A Framework for Establishing Evidence-Based Standards (2015) / Chapter Skim
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4 Standards for Reviewing the Evidence
4 Standards for Reviewing the Evidence
Pages 73-94
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From page 73... ...
suggested that a regulatory body be formed to conduct high-quality systematic reviews for psychosocial interventions, with the aim of providing stakeholders guidance on which practices are evidence based and which need further evaluation. Their proposed regulatory body was patterned after the U.S.
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From page 74... ...
However, the result has been sets of guidelines that often are at odds with one another.1 Consequently, clinicians, consumers, providers, educators, and health care organizations seeking information are given little direction as to which reviews are accurate and which guidelines should be employed. A standardized and coordinated process for conducting systematic reviews and creating practice guidelines and implementation tools has the potential to mitigate confusion in the field.
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WHO SHOULD BE RESPONSIBLE FOR REVIEWING THE EVIDENCE? Over the decades, professional organizations, consumer groups, and scientific groups have produced independent systematic reviews, metaanalyses, and practice guidelines for psychosocial interventions.
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. Both employ a coordinated process for conducting systematic reviews and creating guidelines based on internationally agreed-upon standards, and both have a process for evaluating the impact of guidelines on practice and outcomes.
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. The ESP is charged with conducting systematic reviews and creating guidelines for nominated health care topics.
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Department of Health and Human Services (HHS) , in partnership with professional and consumer organizations, to develop a coordinated process for conducting systematic reviews of the evidence for psychosocial interventions and creating guidelines and implementation materials in accordance with the IOM standards for guideline development.
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The EPCs would report the results of the systematic reviews of the evidence for psychosocial interventions to the guideline panels, which would then create practice guidelines accordingly. HHS could work with SAMHSA's NREPP (SAMHSA, 2015)
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WHAT PROCESS SHOULD BE USED FOR REVIEWING THE EVIDENCE? The IOM standards for systematic reviews have been adopted globally, and are now employed in countries with a formal process for determining whether a psychosocial intervention is indicated for a given problem (Qaseem et al., 2012)
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From page 81... ...
Often, questions related to moderators that facilitate or obstruct an intervention's success, such as intervention characteristics, required clinician skill level, systems needed to support intervention fidelity, and essential treatment elements, are not included in systematic reviews, yet their inclusion is necessary to ensure that the intervention and its elements are implemented appropriately by health plans, clinicians, and educators. It is well known that interventions such as assertive community treatment and psychotherapies such as cognitive-behavioral therapy are complex and may not need to be implemented in their entirety to result in a positive outcome (Lyon et al., 2015; Mancini et al., 2009; Salyers et al., 2003)
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In sum, systematic reviews for psychosocial interventions should address the following questions: • Intervention efficacy -- Is the intervention effective? How is its ef fectiveness defined and measured?
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Once that information has been identified, it is reviewed for its quality with respect to providing definitive answers to the review questions. This review involves grading the quality of the studies' methods and the quality of the evidence generated overall from the existing body of evidence.
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More funding is needed to evaluate these interventions so that systematic reviews can be conducted comprehensively. Data Sources When Evidence Is Insufficient In the health care domain, there often is incomplete or insufficient evidence with which to determine the effects and processes of interventions.
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An example of its use is presented in Box 4-1. The Delphi method -- a form of consensus building used traditionally for expert forecasting, such as predicting how the stock market will look based on economic challenges, is a consensus approach to making recommendations about best practices when insufficient evidence is available.
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As one example, the Cystic Fibrosis Foundation has a registry consisting of health outcomes and clinical characteristics for approximately 26,000 cystic fibrosis patients. This registry has produced important data that now inform treatments used to prolong the survival of these patients.
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When faced with minimal information about the utility of psychosocial interventions in understudied settings and populations, the entity conducting systematic reviews could employ these models to identify candidate best practices and to generate hypotheses about candidate interventions, and could work with research funding agencies (e.g., NIMH, PCORI) to deploy the candidate best practices and study their impact and implementation.
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Expand and enhance processes for coordinating and conducting systematic reviews of psychosocial interventions and their elements.
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Recommendation 4-2. Develop a process for compiling and dissemi nating the results of systematic reviews along with guidelines and dissemination tools.
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Journal of the American Medical Informatics Association 18(5)
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2009. Nonpharmacological intervention for agitation in dementia: A systematic review and meta-analysis.
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2010. A new algorithm for reducing the workload of experts in performing systematic reviews.
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2012. Guidelines international network: Toward international standards for clinical practice guidelines.
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