CG123 Common mental health disorders - National Institute for ...

Systems for organising and developing local care pathwaysThe purpose of this chapter is to examine the evidence for clinical pathways, totry and identify key characteristics of these pathways that are associated with positiveoutcomes. In addition, the GDG aimed to provide advice on the principles by whichlocal care pathways should be established. In any national guidance it is extremelydifficult to prescribe specific care pathways. Therefore the approach taken in thisguideline was to develop some overall principles to guide the development of localcare pathways, drawing on the evidence to underpin and support these principles.7.1.1 Defining clinical care pathwaysClinical care pathways (also referred to as ‘critical pathways’, ‘integrated care pathways’,or simply ‘care pathways’) are defined for the purpose of this guideline assystems designed to improve the overall quality of healthcare by standardising thecare process. In doing so, they seek to promote organised, efficient patient care, basedon best evidence, which is intended to optimise patient outcomes. Usually they drawon clinical guidance (for example, technology appraisals and clinical guidelines) assources of evidence. Clinical care pathways are usually multidisciplinary in structureand, importantly, are focused on a specific group of service users. These service usershave a broadly predictable clinical course in which different interventions providedare defined, optimised and sequenced in a manner appropriate to the needs of theservice users and the setting in which they are provided.A number of recent developments in the NHS in the UK have supported the developmentof clinical care pathways. Of particular note is the development of integratedcare pathways in NHS Scotland (which has seen the development of locally agreedmultidisciplinary and multiagency practice, including pathways for mental healthservices 48 ). In a recently proposed reorganisation of the NHS by Lord Darzi (‘Highquality care for all: NHS Next Stage Review final report’ 49 ), considerable emphasiswas also placed on care pathways as a means to improve healthcare.However, the evidence for the effectiveness of care pathways remains uncertain(Dy et al., 2005; Emmerson et al., 2006). This may be a particular problem in mentalhealth where comorbidities (including mental and physical health problems), andconsiderable difference in severity and uncertainty about treatment options, mean thatspecifying interventions for defined patient groups can be challenging and withconsequent uncertainty about the benefits (Panella et al., 2006; Wilson et al., 1997).7.1.2 Current practice in the National Health ServiceWith the possible exception of the developments in Scotland (described above) therehas been little systematic development of care pathways in the NHS, although it could48 http://www.healthcareimprovementscotland.org/home.aspx49 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825189