In 1995, a statewide project to improve the practice of electroconvulsive therapy (ECT) in the
Medicare population was started in Louisiana. A retrospective baseline study found high
concurrent utilization of lithium and benzodiazepines, medications considered detrimental to
ECT by the second American Psychiatric Association Task Force on ECT. Resistance to a clinical
guideline because of lack of face validity by clinicians was used as an opportunity to involve
clinicians in using data to evaluate their clinical practices. Results of the first two quarters of
the project demonstrated that the strategy was successful.
Get full access to this article
View all access options for this article.
References
1.
Bech, P., et al.1981. The Hamilton Depression Scale. Evaluation of objectivity using logistic modelsActa Psychiatrica Scandinavia63:290-9.
2.
Cohen, S.L., and C. Lawton.1992. Do benzodiazepines interfere with the action of electroconvulsive therapy?British Journal of Psychiatry160:545-6.
3.
Folstein, M.F., S.E. Folstein, and P.R. McHugh.1975. "Mini-Mental State": Apractical method for grading the cognitive state of patients for the clinicianJournal of Psychiatric Research12:189-98.
4.
Grant, J.B., et al.1996. HCFA's Health Care Quality Improvement Program: The medical informatics challengeJournal of the American Medical Information Association3:15-26.
5.
Herman, R.C., et al.1995. Variation in ECT use in the United StatesAmerican Journal of Psychiatry152:869-75.
6.
Jencks, S.F., and G.R. Wilensky.1992. Health care quality improvement initiative: A new approach to quality assuranceJournal of the American Medical Association268 (7): 900-3.
7.
Johnstone, E.C., et al.1982. The Northwick Park electroconvulsive therapy trialLancet2:1317-20.
8.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO).1996. A guide to performance improvement in behavioral health care organizations. Cycle for improving peiformance-MeasureOakbrook Terrace, IL: JCAHO.
9.
Kaplan, H., B. Sadock, and J. Grebb.1994. Synopsis of psychiatryBaltimore, MD: Williams and Wilkins.
10.
Krishna, N.R., M.A. Taylor, and R. Abrams.1978. Response to lithium carbonateBiological Psychiatry13:601-6.
11.
Kukopulos, A., et al.1987. Electroconvulsive therapy In Depression and mania: Modem lithium therapy, edited by F. N. Johnson, 177-80. Washington, DC: IRL Press.
12.
Lobach, D.F.1995. A model for adapting clinical guidelines for electronic implementation in primary care In Proceedings of the Annual Symposium on ComputerApplications in Medical Care , 581-5. Durham, NC: Duke University Medical Center .
13.
Penny, J.F., et al.1990. Concurrent and close temporal administration of lithium and ECTConvulsive Therapy6:139-45.
14.
Pettinati, H.M., et al.1990. Evidence for less improvement in depression in patients taking benzodiazephines during unilateral ECTAmerican Journal of Psychiatry147(8):1029-35.
15.
Shapiro, D.W., et al.1993. Containing costs while improving quality of care: The role of profiling and practice guidelinesAnnual Review of Public Health14:219-41.
16.
Small, J.G., et al.1980. Complications with electroconvulsive treatment combined with lithiumBiological Psychiatry15:103-12.
17.
Small, J.G., and V. Milstein.1990. Lithium interactions: Lithium and electroconvulsive therapyJournal of Clinical Psychopharmacology10:346-50.
18.
Standish-Barry, H.M., V. Deacon, and R.P. Snaith.1985. The relationship of concurrent benzodiazepine administration to seizure duration I ECTActa Psychiatrica Scandinavia71:269-71.
19.
Stromgren, L.S., et al.1980. Factors influencing seizure duration and number of seizures applied in unilateral electroconvulsive therapyActa Psychiatrica Scandinavia62:158-65.
20.
Weiner, R.D., et al.1990. The American Psychiatric Association Task Force on Electroconvulsive Therapy. The practice of electroconvulsive therapy: Recommendations for treatment, training and privilegingWashington, DC: American Psychiatric Association .
