Email updates

Keep up to date with the latest news and content from BMC Psychiatry and BioMed Central.

Open Access Research article

An approach to measure compliance to clinical guidelines in psychiatric care

Tord Forsner1*, Anna Åberg Wistedt2, Mats Brommels34 and Yvonne Forsell1

Author Affiliations

1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden

2 Department of Clinical Neuroscience, Section of Psychiatry St Göran's Hospital, Karolinska Institutet, Stockholm, SE-112 81, Sweden

3 Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, SE-171 77 Sweden

4 Department of Public Health, University of Helsinki, Helsinki, Finland

For all author emails, please log on.

BMC Psychiatry 2008, 8:64  doi:10.1186/1471-244X-8-64

Published: 25 July 2008



The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines.


In this observational study four psychiatric clinics each participated in active implementation of the clinical guidelines for the assessment and treatment of depression and guidelines for assessment and treatment of patients with suicidal behaviours developed by The Stockholm Medical Advisory Board for Psychiatry. The implementation programme included seminars, local implementation teams, regular feedback and academic visits. Additionally two clinics only received the guidelines and served as controls. Compliance to guidelines was measured using indicators, which operationalised requirements of preferred clinical practice. 725 patient records were included, 365 before the implementation and 360 six months after.


Analyses of indicators registered showed that the actively implementing clinics significantly improved their compliance to the guidelines. The total score differed significantly between implementation clinics and control clinics for management of depression (mean scores 9.5 (1.3) versus 5.0 (1.5), p < 0.001) as well as for the management of suicide (mean scores 8.1 (2.3) versus 4.5 (1.9), p < 0.001). No changes were found in the control clinics and only one of the OR was significant.


Compliance to clinical guidelines measured by process indicators of required clinical practice was enhanced by an active implementation.