Eight‐Year Progression of Clinical Practice Implementation Following Guideline Training in the EGUIDE Project

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Abstract
Aim: Clinical practice guidelines have improved the quality and standardization of psychiatric care; however, their long‐term implementation in real‐world settings remains limited. The Effectiveness of the Guidelines for Dissemination and Education (EGUIDE) project was established to promote sustained evidence‐based practice through a multilayered educational program for psychiatrists in Japan. Methods: This multicenter observational study longitudinally tracked psychiatrists' self‐rated clinical behavior (CB) scores related to guideline adherence for up to 8 years after initial EGUIDE participation. CB was assessed using a validated questionnaire covering general guideline use (CB‐G), schizophrenia (CB‐S), and major depressive disorder (CB‐D), with a comprehensive index (CB‐C) representing the mean of all domains. Data were analyzed using the Kruskal–Wallis test, the Mann–Whitney U test, and the Bonferroni correction (two‐tailed p < 0.05). Results: A total of 1562 psychiatrists (mean age, 32.7 ± 7.1 years) were included. All CB indices (CB‐C, CB‐G, CB‐S, and CB‐D) significantly improved post training compared with the baseline (H = 831.2–984.0; all p < 10 −72 ), with small‐to‐moderate effect sizes ( r = 0.09–0.29). These improvements were maintained throughout the 8‐year follow‐up, with no significant decline, and several domains showed small but continued increases between 3 and 7 years post training. Conclusion: The EGUIDE program achieved long‐term, sustained improvements in psychiatrists' guideline‐adherent clinical behaviors through an integrated system combining education, supervision, feedback, and follow‐up. This autonomous, cyclical framework represents a high‐impact model for continuous quality improvement and may be adaptable to other medical specialties.
Funding Information
  • Japan Agency for Medical Research and Development (JP16dk0307060)
  • Japan Agency for Medical Research and Development (JP19dk0307083)
  • Japan Agency for Medical Research and Development (JP22dk0307112)
  • Japan Society for the Promotion of Science (JP21K17261)
  • Japan Society for the Promotion of Science (JP23K16273)
  • University of Tokyo
  • Kawasaki Medical School
  • Kanazawa Medical University
  • Yokohama City University
  • University of the Ryukyus
  • National Institute of Mental Health
  • National Center of Neurology and Psychiatry

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