found that of the 21 cross-sectional studies showing unequivocal results, only 24 percent documented adequate adherence to the aspect(s) of the practice guidelines under study. Of 5 pre/post studies, only 2 showed adequate adherence rates. When these two groups of naturalistic studies were combined, only 27 percent demonstrated adequate rates of adherence. Better adherence was observed in 6 of the 9 controlled trials reviewed1 (Bauer, 2002). Subsequent studies have continued to document clinicians’ departures from evidence-based practice guidelines for conditions as varied as attention deficit hyperactivity disorder (ADHD) (Rushton et al., 2004), anxiety disorders (Stein et al., 2004), conduct disorders in children (Zima et al., 2005), comorbid mental and substance-use illnesses (Watkins et al., 2001), depression in adults (Simon et al., 2001) and children (Richardson et al., 2004), opioid dependence (D’Aunno and Pollack, 2002), use of illicit drugs (Friedmann et al., 2001), and schizophrenia (Buchanan et al., 2002).

As in general health care, M/SU care received by members of racial and ethnic minorities is even less consistent with standards for effective care than that received by nonminority members. Two nationally representative studies found that members of ethnic minorities were less likely to receive appropriate care for depression or anxiety than were white Americans (Wang et al., 2000; Young et al., 2001). Likewise, facilities dispensing methadone for the treatment of opioid dependence that have a greater percentage of African American patients have been shown to be more likely to dispense low and ineffective doses (D’Aunno and Pollack, 2002).

A 1999 comparison of the performance of 67.7 percent of the nation’s health maintenance organizations (HMOs) on five measures of the quality of mental health care2 and nine measures3 of the quality of general health care found that the HMOs delivered mental health care in accordance with standards of care on average 48 percent of the time, compared with an average of 69 percent for the nine general health care measures (Druss et al., 2002). In a landmark study of the quality of a wide variety of health care received by U.S. citizens, individuals with many different types of illnesses received guideline-concordant care about 50 percent of the time, whereas those with alcohol dependence received care consistent with scientific knowledge only about 10.5 percent of the time (McGlynn et al., 2003).


This was attributed to the multifaceted and intensive strategies employed to facilitate and maintain the uptake of these practice guidelines.


Timely ambulatory care after inpatient hospitalization (two measures), medication management of depression (two measures), and outpatient care for depression (one measure).


Adolescent immunizations, use of specific drugs after a heart attack, breast cancer screening, child immunizations, delivery of prenatal care in the first trimester, postpartum check-ups, cervical cancer screening, cholesterol screening, and eye examinations for diabetics.

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