P Sciarini

And how shall we deal with adaptation and implementation of NICE schizophrenia guidelines in Italy

During the 1990s Evidence-Based Medicine emphasized the need to promote evidence-based practice, leading to a rise of practice guidelines throughout medicine (Audet et al., 1990; Lomas, 1991), and expanding the systematic use of scientific evidence in clinical decisionmaking (Guyatt & Rennie, 2002). Though administrators, clinicians, advocates and researchers generally agree that they should provide the most effective mental health treatments, implementing evidence-based practices in standard settings is not straightforward (Drake et al., 2003). Indeed, there is some evidence to suggest that organisational culture may be a relevant factor in health care performance, still articulating the nature of that relationship proves tricky. Current policy prescriptions, which seek service improvements through organisational transformation, are in need of a more secure evidential base (Scott et al., 2003). Evidence-Based Medicine currently enjoys a good reputation in Italy (Ballini & Liberati, 2004), but the complexity and potential utility of information now available for guiding policy and practice decisions make vital methods for synthesis, adaptation and implementation of research information (Anderson et al., 2005). However, simply publishing and distributing clinical guidelines – formulated to help to translate the scientific evidence literature into concise statements (Rogers, 1995) – is not enough to change the practice of clinicians (Cabana et al., 1999). The mental health field is no exception (Hickie & Blashki, 2006) – practice guidelines being perceived as externally imposed and cost-containment tools rather than as decision-supporting tools (Grilli et al., 1996; Formoso et al., 2001). The NICE-Schizophrenia Guidelines (SG) (National Collaborating Centre For Mental Health, 2003) were translated into Italian at a significant time as concerns upcoming review of National mental health care models (Carrà et al., 2004). NHS mental health services in England and in Italy, share indeed principles – e.g. providing a universal and comprehensive service with equal access for all, free at the point of use, based on clinical need, not ability to pay – but also weaknesses such as difficulties in translating the best research evidence available to implementable clinical practice recommendations (Carrà et al., 2004; Kendall et al., 2004; 2005). In a word, translating good guidelines does not ensure their use in practice in Italian mental health services. Therefore, to maximise the likelihood of NICE-SG being used we need somewhat coherent dissemination and implementation strategies to capitalise on known positive factors and to deal with obstacles to implementation that have to be identified (Feder et al., 1999; Grol et al., 2005). G. Carrà et al.

S14-01 Geographical variations for addiction risk among dually diagnosed people cared in parallel systems

Objective Concerns are growing from increasing prevalence rates for comorbid substance misuse and mental illness. Along with understanding which clinical populations are at high risk, an epidemiologically informed approach is needed to assess effectiveness of established service delivery. The aims of the study is to investigate the risk of developing an alcohol and other psychoactive substances dependence syndrome according to area of residence. Method A cross-sectional survey design was used analysing data from the Psychiatric and Addictive Dual Disorders in Italy Study. Staff rating was used to assess comorbid substance use. Results Significant differences were found between different geographical areas (Northern vs. Centre vs. Southern Italy). Peculiar diagnostic subgroups showed higher risk to develop such comorbid condition, whilst a number of clinical and sociodemographic variables, including area of residence, were associated with the risk to develop a dependence syndrome. Conclusions High comorbid rates do not seem necessarily the direct result of biological features inherent in schizophrenia, but social factors play an important role. A number of risk factors associated with dual diagnosis could build up an evidence base about how many people with dual diagnosis present and what the nature of their substance use is, providing targeted service planning and policy making. The higher risk of developing a dependence syndrome as associated with area of residence, could be considered as a reliable proxy measure of effective integration between mental health and addiction services. There is the need for implementing appropriate shared programmes to fill this gap in targeted areas.

S62-02 Alcohol misuse in people with schizophrenia: Findings from the paddi (psychiatric and addictive dual diagnosis in Italy) study

Background Comorbid alcohol misuse in schizophrenia and severe mental illness is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for alcohol misuse. Most evidence about the prevalence of this comorbidity comes from the USA, Canada and Australia, and, though at a different pace, also from Europe. Method A cross-sectional survey design has been used to determine the prevalence In Italy of comorbid drug and alcohol and any - even minor - mental disorders. Staff ratings was used to assess comorbid substance use. Results Though overall dual diagnosis prevalence is around 2%, significantly higher rates were found in inner cities. Furthermore significant differences were found between different geographical areas (Northern vs. Centre vs. Southern Italy). Peculiar diagnostic subgroups showed higher risk to develop such comorbid condition, whilst a number of clinical and sociodemographic variables, including area of residence, were associated with the risk to develop a dependence syndrome. Conclusions Sampling and assessment procedures are major limitations which might explain the lower rates as compared with the current Anglo-Saxon literature. However, such variability emphasizes also that high comorbid alcohol misuse rates are not necessarily the direct result of biological features inherent in schizophrenia, but that social factors play an important role. Finally, a number of risk factors associated with dual diagnosis could build up an evidence base about the nature of their substance use, providing targeted service planning and policy making.