An awareness session conducted for physicians of the psyhciatry department at KSUMC on Monday 25/11/2019 at King Khalid University Hospital, Riyadh, KSA

1. Evidence-Based
Clinical Practice Guidelines
‘for Psychiatrists’
By
Dr. Yasser S. Amer
MBBCh, MPedia, MHI, CPHQ, FISQua, IPFPH
CPG Unit, QMD, KKUH
CPG Steering Committee, KSUMC
Research Chair for EBHC-KT
Pediatrics, KKUH

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4. The EBM Triad
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5. Evidence-Based (Best Practice) Psychiatry
My Clinical
Experience
Best
evidence
Patient
values
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6. Best Evidence
Evidence-Based
Psychiatry
CPGs
(Recommendati
ons + Evidence)
PIPOH
(CPG Websites)
Evidence
PICO
(EBM Websites)
Traditional
Textbooks
Journals
Experts
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8. Evidence Pyramid
SR
RCT
Cohort
Case control
Case series
Case report
Expert opinion
I
II
III
IV
A
B
C
LevelsofEvidence
GradesofRecommendations
MA
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9. The proposed new EBM pyramid.
M Hassan Murad et al. Evid Based Med 2016;21:125-127
©2016 by BMJ Publishing Group Ltd
New evidence pyramid
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10. CPG-related Accreditation Standard(s)
Clinical practice guidelines,
pathways, and protocols are
developed or adopted to guide
priority care services.
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What makes a trustworthy CPG?
EB-CPGs for Psyhciatrists by Y. S. Amer

12. Standards for high quality CPGs
IOM 2011 – G-I-N 2012 – AGREE 2013
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13. Standards for trustworthy CPGs
IOM 2011 G-I-N 2012
1- Establishing Transparency 1- Decision making process. 2- Methods
2- Management of COI 3- COI
3- (GDG) composition 4- GDG composition
4- (CPG – SR) intersection 5- Evidence reviews
5- Assign/ link to (LoE) & (GoR) 6- Rating of E & Rs
6- Articulation of (Rs) 7- CPG Rs (formulation/ wording)
7- External Review 8- Peer review & stakeholder consultation
8- Updating 9- Expiration & updating
10- Scope of CPG
11- Financial support/ sponsoring organization
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14. GRADE
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More than 100
organizations from 19
countries around the
world have endorsed
or are using GRADE
(e.g. WHO, ACP, BMJ,
ACCP, NICE, SIGN,
AHRQ, Cochrane, etc.)
GRADE: The Grading of
Recommendations Assessment,
Development and Evaluation

15. Types of CPGs
1.Evidence-Based CPGs (evidence-
based methodology)
2.Consensus/ expert-based CPGs
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Which type do you think is
better?
EB-CPGs for Psyhciatrists by Y. S. Amer

16. ‫الجامعية‬‫الطبية‬‫المدينة‬-
KSUMC
Quality Management Department
Approach: Methodology (KSU Modified ADAPTE)
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KSU Modified ADAPTE

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18. Organization Name
Country
URL
Producer
Finder
FREE
PAID
Guidelines International Network
(G-I-N)
Int’l http://www.g-i-n.net F √ √
World Health Organization (WHO) Int’l http://www.who.int/topics P √
National Institute for Health
& Care Excellence (NICE)
UK
http://www.nice.org.uk/page.aspx?o=ourguidan
ce
P √ √
Scottish Intercollegiate Guidelines
Network (SIGN)
UK http://www.sign.ac.uk/guidelines/index.html P √
EBSCO Health: DynaMed USA http://www.dynamed.com/home/ F
ECRI Institute: Guidelines Trust USA
https://guidelines.ecri.org/
(successor for National Guidelines
Clearinghouse of AHRQ)
F √
MEDLINE/ PubMed USA
http://www.ncbi.nlm.nih.gov/pubmed
OR http://www.pubmed.gov
F
√
(Abstrac
ts)
√
(Full
Text)
Plus Specialized societies of psychiatry
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CPG online databases
EB-CPGs for Psyhciatrists by Y. S. Amer

19. Resources for Psych. CPGs
• American Psychiatric Association Practice
Guidelines.
• American Academy of Child & Adolescent
Psychiatry Practice Parameters and
Guidelines.
• Canadian Network for Mood and Anxiety
Treatment (CANMAT) Guidelines.
• The Maudsley Prescribing Guidelines (MPG).
• Saudi Psychiatric Association.
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22. 23 Items in 6 Domains
USER’S MANUAL page 7
DOMAINS No. of Items
1 Scope & Purpose 3
2 Stakeholder Involvement 3
3 Rigour of Development
(Methodology)
8
4 Clarity & Presentation 4
5 Applicability 3
6 Editorial Independence 2
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24. Schizophrenia CPGs
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26. Tic Disorders CPGs
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30. Evidence-based CPGs developed by CANMAT and the
International Society for Bipolar Disorder (ISBD) for
Dx and Rx of Bipolar Disorders, designed for use by
community-based psychiatrists and mental health
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31. CPGs Are Not Rules
• Expect the vast majority of practice to fall within
CPGs (80 % - 90 % Rule)
• Deviation from CPGs is allowed for specific patients
with specific circumstances.
• When such deviation occurs an individual clinician
is expected to explain the rationale.
• Strong evidence (Level 1 & 2) are expected to be
followed.
• Weaker evidence (Level 3 & 4) can be handled
differently .
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34. Thank you for
Listening !
Email: yassersamiamer@gmail.com;
yamer@ksu.edu.sa
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