Implementation of Guidelines on Prevention of Coercion and Violence (PreVCo) in Psychiatry: Study Protocol of a Randomized Controlled Trial (RCT)

Tilman Steinert; Andreas Bechdolf; Lieselotte Mahler; Rainer Muche; Johanna Baumgardt; Felix Bühling-Schindowski; Celline Cole; Marie Kampmann; Dorothea Sauter; Angelika Vandamme; Stefan Weinmann; Sophie Hirsch

doi:10.3389/fpsyt.2020.579176

Implementation of Guidelines on Prevention of Coercion and Violence (PreVCo) in Psychiatry: Study Protocol of a Randomized Controlled Trial (RCT)

Front Psychiatry. 2020 Sep 15:11:579176. doi: 10.3389/fpsyt.2020.579176. eCollection 2020.

Authors

Tilman Steinert¹, Andreas Bechdolf^{2

3

4}, Lieselotte Mahler⁵, Rainer Muche⁶, Johanna Baumgardt^{2

7}, Felix Bühling-Schindowski², Celline Cole⁵, Marie Kampmann¹, Dorothea Sauter¹, Angelika Vandamme⁵, Stefan Weinmann^{2

8}, Sophie Hirsch¹

Affiliations

¹ Center for Psychiatry Suedwuerttemberg, Ulm University, Ravensburg-Weissenau, Germany.
² Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital am Friedrichshain, Berlin, Germany.
³ ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
⁴ Department for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany.
⁵ Department of Psychiatry and Psychotherapy (CCM), Charité-University Medicine Berlin, Berlin, Germany.
⁶ Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
⁷ Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁸ Department of Psychiatry and Psychotherapy, University Psychiatric Hospital Basel (UPK), Basel, Switzerland.

Abstract

Background: Coercive measures are among the most controversial interventions in psychiatry. There is a large discrepancy between the sheer number of high-quality guidelines and the small number of scientifically accompanied initiatives to promote and evaluate their implementation into clinical routine. In Germany, an expert group developed guidelines to provide evidence- and consensus-based recommendations on how to deal with violence and coercion in psychiatry.

Methods: The study presented examines whether coercive measures on psychiatric wards can be reduced by means of an operationalized implementation of the guidelines "Prevention of coercion: prevention and therapy of aggressive behavior in adults". Out of a set of 12 interventions offered, wards are free to choose three interventions they want to implement. The primary outcome is the number of coercive measures per bed and month/year. Secondary outcomes are cumulative duration of coercive measures per bed and month/year. The most important control variable is the number of aggressive incidents. We plan to recruit 52 wards in Germany. Wards treating both voluntary and compulsorily admitted patients will be included. A 1:1 stratified randomized controlled trial will be conducted stratified by the amount of coercive measures and implemented aspects of the guidelines. In addition to the control group analysis, a waiting list design allows a pre-post analysis for all participating wards of the waiting list group. A parallel qualitative study will examine factors related to successful implementation and to successful reduction of coercion as well as relevant barriers.

Discussion: We are planning a nationwide study on the implementation of evidence- and consensus-based guidelines in psychiatric hospitals. This study intends to promote the transfer of expert knowledge as well as results from clinical trials into clinical routine with the potential to change supply structures in mental health sector.

Clinical trial registration: www.isrctn.com, identifier ISRCTN71467851.

Keywords: clinical guidelines; coercive measures; evidence based treatment; psychiatry; quality management; restraint; seclusion; violence.