Association Between Psychiatrists' Subjective Clinical Behavior Scores and Objective Quality Indicators Based on Discharge Prescriptions: A Nationwide Multicenter Study Based on the EGUIDE Project.

AIM: Psychiatrists often perceive their clinical practices as guideline-concordant; however, discrepancies frequently exist between perceived and actual prescribing behaviors. To explore this gap, we examined the association between self-assessed clinical behavior scores (CBs) and prescribing practices objectively evaluated using quality indicators (QIs) within the EGUIDE educational program framework for schizophrenia and major depressive disorder. Identifying such associations is essential for improving care quality and developing interventions fostering evidence-based practice.

METHODS

A prospective observational multicenter study was conducted across Japan involving 820 psychiatrists from university, public, and private hospitals participating in EGUIDE, along with patients diagnosed with schizophrenia (n = 6714) or major depressive disorder (n = 3692) treated at these institutions. The outcome measures were associations between psychiatrists' CB scores and quality indicators (QIs) based on discharge prescriptions; these were analyzed using logistic regression adjusted for age, sex, and institution type.

RESULTS

For schizophrenia, CBs were significantly associated with 8 of 11 QIs, including treatment-resistant assessment, antipsychotic monotherapy (with/without other psychotropics), absence of anxiolytics/hypnotics, mood stabilizers, anticholinergics, PRN psychotropics, and clozapine use. For major depressive disorder, 3 of 7 QIs showed significant associations: severity assessment, no anxiolytic/hypnotic prescriptions, and use of modified electroconvulsive therapy.

CONCLUSION

Self-assessed clinical behavior scores partially reflect actual prescribing practices. These findings highlight the value of incorporating subjective evaluations into clinical performance assessment tools to promote guideline adherence. Moreover, our results suggest that collecting self-assessments may offer a feasible and scalable strategy for identifying areas where additional education or system-level support is needed to enhance evidence-based prescribing in diverse clinical settings.

TRIAL REGISTRATION: University Hospital Medical Information Network registry identifier: UMIN000022645.