In order to ensure that clinical decisions are adequate, efficient and safe, healthcare professionals with updated knowledge and skills are required.

Although scientific information is more accessible than ever, the large number of references, lack of time and need to grade the importance of scientific evidence make certain tools aimed at supporting clinical decision-making necessary. Clinical Practice Guidelines (CPGs) provide answers to the most relevant questions regarding a patient with a specific pathology and present scientific evidence in the form of graded recommendations based on the quality of the studies that support them.

Given that CPGs facilitate the thousands of clinical decisions made daily in healthcare and that they are a tool to improve health outcomes, the Quality Agency supports their development, dissemination and use, while ensuring that CPGs developed in Spain are high quality.

In the year 2003, the National Health System’s Interterritorial Council created the HealthGuide project, which aims ultimately to improve evidence-based clinical decision-making by means of training activities and the configuration of a Clinical Practice Guidelines (CPG) register in the NHS. Since then, the HealthGuide project has assessed dozens of CPGs in accordance with explicit criteria generated by its scientific committee, registered these CPGs and disseminated them throughout the Internet.

In early 2006, the Directorate General of the National Health System Quality Agency elaborated the Quality Plan for the NHS, a plan that encompasses twelve strategies.

The objective of this Plan is to increase cohesion of the NHS and aid in guaranteeing maximum quality healthcare to all citizens, regardless of their place of residence.

The plan’s tenth strategy is aimed at improving clinical practice, its objectives being the reduction of variability in clinical practice and the promotion of the development and use of CPGs. HealthGuide and the CPG development program are responding to the objectives set forth in the Quality Plan, the former in terms of the creation of a registry, training and consultancy, and the latter in terms of the creation of new guidelines.

In 2006, the development of eight CPGs on prevalent pathologies related with health strategies was assigned to different agencies and experts groups. This updated clinical practice guideline on schizophrenia and incipient psychotic disorder is part of this assignment.

Additionally, the establishment of a common CPG development methodology within the NHS was requested. This assignment was shaped into a Methodological manual for the development of CPGs, which has been available to all professionals since November 2007. It is the reference methodological manual employed for the development of all guidelines created in this program. At present, fourteen more guidelines are in the process of being developed, in collaboration with the same institutions and with the participation of the scientific societies involved.

In 2007 the HealthGuide project was reworked and the Clinical Practice Guidelines Library was created. This project delves deeper into the development of CPGs and includes other services and products of Evidence-Based Medicine that are aimed at supporting clinical decision-making. It also emphasises diffusion, dissemination and implementation of CPGs to boost their use, as well as the assessment of health outcomes in the population.

Schizophrenia and other forms of psychosis represent an important public health problem, given that these disorders can severely affect the psychological and social development of patients and their family and social environment.

However, scientific advances in the past few years have ignited a renewed sense hope in regards to its treatment and rehabilitation of patients. Likewise, recent studies demonstrate that clinical course can vary with early and specific interventions adapted to the early phases of these disorders.

In this sense, the World Health Organisation (WHO), together with the International Association of Incipient Psychosis, made a public declaration in 2005 to promote early intervention and the recovery of young people with early psychosis.

This CPG on schizophrenia and incipient psychotic disorder is also an update of the guideline published in 2003 and incorporates more contents, including information on incipient psychotic disorders. It aims to provide professionals and users of healthcare services with rigorous information on available scientific evidence for the treatment of these disorders, thus facilitating the development of preventive, therapeutic and rehabilitation interventions that improve the clinical course, prognosis and quality of life of affected patients and their family and social environment.

Pablo Rivero Corte
General Director
Quality Agency of the National Health System