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Williams NJ, Ehrhart MG, Aarons GA, Esp S, Sklar M, Carandang K, Vega NR, Brookman-Frazee L, Marcus SC. Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial. Implement Sci 2024; 19:29. [PMID: 38549122 PMCID: PMC10976812 DOI: 10.1186/s13012-024-01356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Theory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI's hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI's effect on implementation climate, which in turn will (3) mediate LOCI's effect on MBC fidelity. METHODS Twenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders' implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses. RESULTS LOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI's effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI's improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [pm] = 0.82, p = .004). Transformational leadership did not mediate LOCI's effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI's effect on MBC fidelity during the same period (pm = 0.71, p = .045). CONCLUSIONS LOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.
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Affiliation(s)
- Nathaniel J Williams
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA.
- School of Social Work, Boise State University, Boise, ID, 83725, USA.
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Susan Esp
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA
- School of Social Work, Boise State University, Boise, ID, 83725, USA
| | - Marisa Sklar
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Nallely R Vega
- School of Social Work, Boise State University, Boise, ID, 83725, USA
| | | | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Painter J, James M. Reliability testing of the Health of the Nation Outcome Scales 2018. J Psychiatr Ment Health Nurs 2024. [PMID: 38497357 DOI: 10.1111/jpm.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT The Health of the Nation Outcome Scales (HoNOS) is a widely used clinical measure designed to rate and monitor the outcomes of service users accessing specialist mental healthcare. Since its development (in 1996), numerous research studies have confirmed the HoNOS captures the aspects of care that it purports to (validity), and that clinicians' ratings are consistent both over time, and between different raters (reliability). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE In 2018, the HoNOS was reviewed with updates made to some terminology and other revisions intended to remove ambiguity in the guidance for raters. However, although the new version (HoNOS 2018) was accompanied by a recommendation that its validity and reliability be re-tested this was not undertaken. To our knowledge, this is the first study to re-assess the updated tool's reliability by measuring the level of agreement between different raters. Our findings confirm that there is an acceptable level of consistency between student mental health nurses that have been trained to use the (new) HoNOS 2018. WHAT ARE THE IMPLICATIONS FOR PRACTICE The HoNOS is nationally mandated for use by all specialist mental healthcare providers in the UK. Our findings provide some assurance that, with appropriate update training and monitoring of organisational-level data sets, the original HoNOS glossary can safely be replaced with the HoNOS 2018 to ensure more contemporary routine outcome measurement can occur. ABSTRACT INTRODUCTION: The Health of the Nation Outcome Scales (HoNOS) is a well-established clinician rated outcome measure for use in mental health services. Following an international review, an updated version (HoNOS 2018) was published with a recommendation that its psychometric properties be re-tested prior to widespread implementation. To date, only one such study has been published. AIMS To test the inter-rater agreement levels for HoNOS 2018. METHOD Third-year student mental health nurses received training to complete the HoNOS 2018. Following this timetabled session, they were each invited to independently rate two, randomly selected, videos of (simulated) patient interviews. The resulting data were then analysed to calculate the tool's internal consistency and inter-rater agreement levels. RESULTS The 55 participants provided 106 ratings from four vignettes. Cronbach's alphas and McDonalds omegas confirmed the revised tool's internal consistency was acceptable. Average measure intraclass correlation coefficients for the four patient vignettes indicated excellent reliability. IMPLICATIONS FOR PRACTICE This study provides initial assurance that the HoNOS 2018 is a reliable clinician rated outcome measure suitable for use in routine clinical practice by relatively inexperienced mental health practitioners with limited training.
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Affiliation(s)
- Jon Painter
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Mick James
- Royal College of Psychiatrists, London, UK
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McDaniel BT, Cornet V, Carroll J, Chrones L, Chudzik J, Cochran J, Guha S, Lawrence DF, McCue M, Sarkey S, Lorenz B, Fawver J. Real-world clinical outcomes and treatment patterns in patients with MDD treated with vortioxetine: a retrospective study. BMC Psychiatry 2023; 23:938. [PMID: 38093196 PMCID: PMC10720213 DOI: 10.1186/s12888-023-05439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study included evaluation of the effectiveness of vortioxetine, a treatment for adults with major depressive disorder (MDD), using patient-reported outcome measures (PROMs) in a real-world setting. METHODS This retrospective chart review analyzed the care experiences of adult patients with a diagnosis of MDD from Parkview Physicians Group - Mind-Body Medicine, Midwestern United States. Patients with a prescription for vortioxetine, an initial baseline visit, and ≥ 2 follow-up visits within 16 weeks from September 2014 to December 2018 were included. The primary outcome measure was effectiveness of vortioxetine on depression severity as assessed by change in Patient Health Questionnaire-9 (PHQ-9) scores ~ 12 weeks after initiation of vortioxetine. Secondary outcomes included changes in depression-related symptoms (i.e., sexual dysfunction, sleep disturbance, cognitive function, work/social function), clinical characteristics, response, remission, and medication persistence. Clinical narrative notes were also analyzed to examine sleep disturbance, sexual dysfunction, appetite, absenteeism, and presenteeism. All outcomes were examined at index (start of vortioxetine) and at ~ 12 weeks, and mean differences were analyzed using pairwise t tests. RESULTS A total of 1242 patients with MDD met inclusion criteria, and 63.9% of these patients had ≥ 3 psychiatric diagnoses and 65.9% were taking ≥ 3 medications. PHQ-9 mean scores decreased significantly from baseline to week 12 (14.15 ± 5.8 to 9.62 ± 6.03, respectively; p < 0.001). At week 12, the response and remission rates in all patients were 31.0% and 23.1%, respectively, and 67% continued vortioxetine treatment. Overall, results also showed significant improvements by week 12 in anxiety (p < 0.001), sexual dysfunction (p < 0.01), sleep disturbance (p < 0.01), cognitive function (p < 0.001), work/social functioning (p = 0.021), and appetite (p < 0.001). A significant decrease in presenteeism was observed at week 12 (p < 0.001); however, no significant change was observed in absenteeism (p = 0.466). CONCLUSIONS Using PROMs, our study results suggest that adults with MDD prescribed vortioxetine showed improvement in depressive symptoms in the context of a real-world clinical practice setting. These patients had multiple comorbid psychiatric and physical diagnoses and multiple previous antidepressant treatments had failed.
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Affiliation(s)
- Brandon T McDaniel
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Victor Cornet
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanne Carroll
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | | | - Joseph Chudzik
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanette Cochran
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US
| | - Shion Guha
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
- Faculty of Information, Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | | | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Sara Sarkey
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Betty Lorenz
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Jay Fawver
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US.
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Cho E, Cook JR, Hawley KM. A Structural Model of Organization and Clinician Factors Associated with Standardized Measure Use in a National Survey of Youth Mental Health Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:876-887. [PMID: 37458956 PMCID: PMC11056910 DOI: 10.1007/s10488-023-01286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 10/01/2023]
Abstract
Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making.
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Affiliation(s)
- Evelyn Cho
- University of Missouri, Columbia, USA
- Harvard University, Cambridge, USA
| | - Jonathan R Cook
- University of Missouri, Columbia, USA
- Pacific Anxiety Group, Belmont, USA
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Brown-Johnson C, Calma J, Amano A, Winget M, Harris SR, Vilendrer S, Asch SM, Heidenreich P, Sandhu AT, Kalwani NM. Evaluating the Implementation of Patient-Reported Outcomes in Heart Failure Clinic: A Qualitative Assessment. Circ Cardiovasc Qual Outcomes 2023; 16:e009677. [PMID: 37114990 PMCID: PMC10192029 DOI: 10.1161/circoutcomes.122.009677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) may improve care for patients with heart failure. The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) is a patient survey that captures symptom frequency, symptom burden, physical limitations, social limitations, and quality of life. Despite the utility of PROs and the KCCQ-12, the implementation and routine use of these measures can be difficult. We conducted an evaluation of clinician perceptions of the KCCQ-12 to identify barriers and facilitators to implementation into clinical practice. METHODS We conducted interviews with cardiologists from 4 institutions across the United States and Canada (n=16) and observed clinic visits at 1 institution in Northern California (n=5). Qualitative analysis was conducted in 2 rounds: (1) rapid analysis constructed around major themes related to the aims of the study and (2) content analysis with codes derived from the rapid analysis and implementation science. RESULTS Most heart failure physicians and advanced practice clinicians reported that the KCCQ-12 was acceptable, appropriate, and useful in clinical care. Clinician engagement efforts, trialability, and the straightforward design of the KCCQ-12 facilitated its use in clinical care. Further opportunities identified to facilitate implementation include more streamlined integration into the electronic health record and comprehensive staff education on PROs. Participants highlighted that the KCCQ-12 was useful in clinic visits to improve the consistency of patient history taking, focus patient-clinician conversations, collect a more accurate account of patient quality of life, track trends in patient well-being over time, and refine clinical decision-making. CONCLUSIONS In this qualitative study, clinicians reported that the KCCQ-12 enhanced several aspects of heart failure patient care. Use of the KCCQ-12 was facilitated by a robust clinician engagement campaign and the design of the KCCQ-12 itself. Future implementation of PROs in heart failure clinic should focus on streamlining electronic health record integration and providing additional staff education on the value of PROs. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT04164004.
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Affiliation(s)
- Cati Brown-Johnson
- Division of Primary Care and Population Health (C.B.-J., A.A., M.W., S.H., S.V., S.M.A.), Department of Medicine, Stanford University School of Medicine, CA
| | - Jamie Calma
- Division of Cardiovascular Medicine (J.C., P.H., A.T.S., N.M.K.), Department of Medicine, Stanford University School of Medicine, CA
| | - Alexis Amano
- Division of Primary Care and Population Health (C.B.-J., A.A., M.W., S.H., S.V., S.M.A.), Department of Medicine, Stanford University School of Medicine, CA
| | - Marcy Winget
- Division of Primary Care and Population Health (C.B.-J., A.A., M.W., S.H., S.V., S.M.A.), Department of Medicine, Stanford University School of Medicine, CA
| | - Sonia R Harris
- Division of Primary Care and Population Health (C.B.-J., A.A., M.W., S.H., S.V., S.M.A.), Department of Medicine, Stanford University School of Medicine, CA
| | - Stacie Vilendrer
- Division of Primary Care and Population Health (C.B.-J., A.A., M.W., S.H., S.V., S.M.A.), Department of Medicine, Stanford University School of Medicine, CA
| | - Steve M Asch
- Division of Primary Care and Population Health (C.B.-J., A.A., M.W., S.H., S.V., S.M.A.), Department of Medicine, Stanford University School of Medicine, CA
- Veteran Affairs Palo Alto Healthcare System, CA (S.M.A.)
| | - Paul Heidenreich
- Division of Cardiovascular Medicine (J.C., P.H., A.T.S., N.M.K.), Department of Medicine, Stanford University School of Medicine, CA
- Cardiology Section, Medical Service, Veterans Affairs Palo Alto Health Care System (P.H., A.T.S and N.M.K.)
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine (J.C., P.H., A.T.S., N.M.K.), Department of Medicine, Stanford University School of Medicine, CA
- Cardiology Section, Medical Service, Veterans Affairs Palo Alto Health Care System (P.H., A.T.S and N.M.K.)
| | - Neil M Kalwani
- Division of Cardiovascular Medicine (J.C., P.H., A.T.S., N.M.K.), Department of Medicine, Stanford University School of Medicine, CA
- Cardiology Section, Medical Service, Veterans Affairs Palo Alto Health Care System (P.H., A.T.S and N.M.K.)
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Wray LO, Oslin DW, Leong SH, Pitcock JA, Tauriello S, Drummond KL, Ritchie MJ. Enhancing Implementation of Measurement-Based Mental Health Care in Primary Care: A Mixed-Methods Study. Psychiatr Serv 2023:appips20220140. [PMID: 36597698 DOI: 10.1176/appi.ps.20220140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The complex practice of measurement-based care (MBC) for mental health conditions has proven challenging to implement. This study aimed to evaluate an intensive strategy to implement MBC in U.S. Department of Veterans Affairs (VA) Primary Care Mental Health Integration clinics. METHODS Ten paired sites were randomly assigned to receive national MBC resources alone or with an intensive implementation strategy (external facilitation plus quality improvement teams) between May 2018 and June 2020. The intervention occurred over 12-18 months; two site pairs completed participation before the COVID-19 pandemic. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, the authors conducted qualitative interviews and used administrative data to evaluate the implementation, adoption, reach, and effectiveness of MBC. RESULTS All sites improved during the study, suggesting the effectiveness of the VA's national MBC initiative. Sites with facilitation improved more than comparison sites in implementation, adoption, and reach of MBC. The effectiveness of MBC (i.e., clinician responsiveness to high patient-reported outcome measure [PROM] scores) was demonstrated at all sites both before and after facilitation. After the COVID-19 pandemic began, facilitation sites maintained or improved on their implementation gains, whereas comparison sites uniformly reported decreased emphasis on MBC. CONCLUSIONS Implementation facilitation resulted in greater gains in outcomes of interest and helped sites retain focus on MBC implementation. Regardless of study condition, clinicians were responsive to elevated PROM scores, but MBC had a larger impact on care at facilitation sites because of increased uptake. Multiple technological and contextual challenges remain, but MBC holds promise for improving routine mental health care.
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Affiliation(s)
- Laura O Wray
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
| | - David W Oslin
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
| | - Shirley H Leong
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
| | - Jeffery A Pitcock
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
| | - Sara Tauriello
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
| | - Karen L Drummond
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
| | - Mona J Ritchie
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA) Center for Integrated Healthcare, Washington, D.C. (Wray, Tauriello); Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Veterans Integrated Service Network (VISN) 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Oslin, Leong); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin); Tigermed-BDM, Somerset, New Jersey (Leong); VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock (Pitcock, Drummond, Ritchie); Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo (Tauriello); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Drummond, Ritchie)
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Morris AC, Ibrahim Z, Moghraby OS, Stringaris A, Grant IM, Zalewski L, McClellan S, Moriarty G, Simonoff E, Dobson RJB, Downs J. Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services. Digit Health 2023; 9:20552076231211551. [PMID: 37954687 PMCID: PMC10638880 DOI: 10.1177/20552076231211551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
Objective This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. Methods We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. Results We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. Conclusion This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.
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Affiliation(s)
- Anna C Morris
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Zina Ibrahim
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Omer S Moghraby
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Emotion & Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ian M Grant
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | - Lukasz Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | | | - Garry Moriarty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | - Richard JB Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
- Health Data Research UK London, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
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8
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Cheung BS, Murphy JK, Michalak EE, Liu J, Yang X, Wang X, Chen J, Lam RW. Barriers and facilitators to technology-enhanced measurement based care for depression among Canadian clinicians and patients: Results of an online survey. J Affect Disord 2023; 320:1-6. [PMID: 36162664 DOI: 10.1016/j.jad.2022.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/12/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Measurement-based care (MBC) is an evidence-based approach that can improve management of depression, but its use in clinical settings remains low. The use of digital technology, or technology-enhanced MBC (eMBC), may address some of the barriers to implementation of MBC by enabling patients to easily complete outcome assessments. This study aims to identify the perceived facilitators and barriers to MBC and eMBC from both patient and provider perspectives in Canada. METHODS The study recruited 108 clinicians and 131 patients with a self-reported diagnosis of depression to participate in an online survey about the acceptability of both MBC and eMBC. RESULTS Most clinicians (90/108, 83.3 %) agreed that MBC is important for clinical judgement, and felt trained to interpret their scores; however, only 43/108 (39.8 %) use MBC routinely. Clinicians (95/108, 88.0 %) felt they would be more likely to use MBC if it was automated and available to use electronically. Most patients (117/131, 89.3 %) felt MBC would be helpful for their treatment and were willing to use a mobile app to track their symptoms. LIMITATIONS Recruitment was done online and, hence, this study may not capture the perspective of patients who are not already familiar with using online programs to complete questionnaires. CONCLUSIONS Clinicians and patients in Canada would be willing to utilize MBC and eMBC in their psychiatric care, but barriers to implementation include perceptions about efficiency, ease of use, and accessibility. These results highlight the importance of engaging both clinicians and patients to effectively implement MBC and eMBC for depression.
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Affiliation(s)
- Bennett Sw Cheung
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill K Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jing Liu
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiaorui Yang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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9
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Leshem YA, Chalmers JR, Apfelbacher C, Katoh N, Gerbens LAA, Schmitt J, Spuls PI, Thomas KS, Howells L, Williams HC, Simpson EL. Measuring Atopic Eczema Control and Itch Intensity in Clinical Practice: A Consensus Statement From the Harmonising Outcome Measures for Eczema in Clinical Practice (HOME-CP) Initiative. JAMA Dermatol 2022; 158:1429-1435. [PMID: 36223090 DOI: 10.1001/jamadermatol.2022.4211] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Measuring outcomes in clinical practice can aid patient care, quality improvement, and real-world evidence generation. The Harmonising Outcome Measures for Eczema (HOME) Clinical Practice initiative is developing a list of validated, feasible instruments to measure atopic eczema in clinical care. Prior work identified symptoms and long-term control as the most important domains to measure in clinical practice. The Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) were recommended by consensus to measure symptoms in clinical practice, but a need for instruments to measure itch intensity specifically was recognized. The HOME group also previously decided that long-term control should be captured by repeated measurements of eczema control. Recommended instruments to measure eczema control in clinical practice have not been defined. Objective To recommend instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice. Evidence Review Available instruments to measure eczema control and itch intensity were identified through systematic reviews, informing a consensus process held at the HOME VIII virtual online meeting (October 6 and October 9, 2020). Feasibility aspects were highlighted to optimize instrument selection for the clinical practice. Consensus on an instrument was reached if fewer than 30% of the voters disagreed. Findings Of 7 identified instruments, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were the recommended instruments to measure eczema control (3 of 63 [5%] and 7 of 69 [10%] of voters disagreed, respectively). A single-question patient global assessment garnered support, but the current available instrument did not reach consensus. Six available itch-intensity instruments were identified. Of them, 3 instruments were recommended by consensus: a peak 24-hour numeric rating scale (NRS)-itch, and 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire, measuring average and peak itch (11 of 63 [17%], 14 of 63 [22%], and 16 of 59 [27%] voters disagreed, respectively). Conclusions and Relevance Clinicians and patients are encouraged to incorporate these well-validated, quick-to-perform, and easy-to-use instruments into their clinic, selecting the instruments that best fit their need. These assessments are meant to enhance, not replace, the patient-clinician encounter, and to support real-world research and health care improvement.
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Affiliation(s)
- Yael A Leshem
- Division of Dermatology, Rabin Medical Center, Petach-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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10
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Christodoulaki A, Baralou V, Konstantakopoulos G, Touloumi G. Validation of the Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in the Greek general population. J Psychosom Res 2022; 160:110970. [PMID: 35728338 DOI: 10.1016/j.jpsychores.2022.110970] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report screening scale for depression and anxiety with promising psychometric properties; however, its reliability and validity have not been investigated in Greece yet. The objective of the current study was to investigate the reliability and validity of the PHQ-4 and to establish a cut-off score to identify depression and anxiety in the Greek general population. METHODS The reliability of the PHQ-4 was assessed using a random sample of 204 students from Athens, Greece. The internal consistency (Cronbach's α) was evaluated whereas the test-retest reliability was measured over a one-week period with intra-class correlation (ICC). The scale's validity was assessed in a cross-sectional study of 591 adults living in Greece using confirmatory factor analysis (CFA). Cut-offs were determined using the Mini International Neuropsychiatric Interview (MINI) as the gold standard. RESULTS Cronbach's α of the PHQ-4 was 0.80 and the overall ICC 0.96. CFA yielded a two-factor model, structurally invariant by age and gender. A GAD-2 score of 2 was the optimal cut-off point to detect any anxiety disorder (sensitivity = 0.82, specificity = 0.75) and 3 to detect generalized anxiety disorder (sensitivity = 0.77, specificity = 0.82). As for PHQ-2, a score of 2 was the optimal cut-off point to detect any depressive disorder (sensitivity = 0.87, specificity = 0.85) and 3 to detect major depressive disorder (sensitivity = 0.77, specificity = 0.94). CONCLUSIONS The PHQ-4 is a reliable and valid screening scale for depression and anxiety in the Greek general population.
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Affiliation(s)
- Anna Christodoulaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Valia Baralou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Konstantakopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece; Research Department of Clinical, Education and Health Psychology, University College London, UK.
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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11
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Harris MG, Tapp C, Arnautovska U, Coombs T, Dickson R, James M, Painter J, Smith M, Jury A, Lai J, Burgess PM. Assessing the Content Validity of the Revised Health of the Nation Outcome Scales (HoNOS 2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9895. [PMID: 36011532 PMCID: PMC9408525 DOI: 10.3390/ijerph19169895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
The Health of the Nation Outcome Scales (HoNOS) comprises 12 scales that cover the kinds of problems that may be experienced by working-age adults in contact with specialised mental health services. Drawing on 20 years' experience in clinical practice, a collaborative, international review of the HoNOS was undertaken and a revised measure (known as the HoNOS 2018) was published. In this study, 32 experts from Australia, England and New Zealand completed an anonymous web-based survey to assess the relevance, comprehensiveness and comprehensibility (aspects of content validity) of the HoNOS 2018. The experts rated 11 of the 12 HoNOS 2018 scales as 'important' or 'very important' for determining the overall clinical severity (item-level content validity index or I-CVI ≥ 0.75). Evaluations of the scales' ability to capture change, comprehensiveness and comprehensibility were more variable, but generally positive. Experts' comments provided further insights into this variability; for example, they noted that some scales combine multiple phenomena, which can result in ambiguity in item wording and assessment challenges. Results from this study suggest that the revisions have not altered the importance of the scales. Given the measure's breadth of content, training remains important for ensuring rating fidelity. Inter-rater reliability and utility testing are indicated.
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Affiliation(s)
- Meredith G. Harris
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
| | - Caley Tapp
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
| | - Urska Arnautovska
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
| | - Tim Coombs
- Australian Mental Health Outcomes Classification Network (AMHOCN), c/- HETI, Locked Bag 2030, St Leonards, NSW 1590, Australia
| | - Rosemary Dickson
- Australian Mental Health Outcomes Classification Network (AMHOCN), c/- HETI, Locked Bag 2030, St Leonards, NSW 1590, Australia
| | - Mick James
- Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, UK
| | - Jon Painter
- Department of Nursing and Midwifery, Collegiate Crescent, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Mark Smith
- Te Pou, Kakariki House, Waikato Mail Centre, 293 Grey St, Hamilton East P.O. Box 307, Hamilton 3240, New Zealand
| | - Angela Jury
- Te Pou, Millennium Centre, Phase II, Building B, Ground Floor, 600 Great South Road, Ellerslie, Auckland 1051, New Zealand
| | - Jennifer Lai
- Te Pou, Millennium Centre, Phase II, Building B, Ground Floor, 600 Great South Road, Ellerslie, Auckland 1051, New Zealand
| | - Philip M. Burgess
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
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12
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Milgram L, Tonarely NA, Ehrenreich-May J. Youth Top Problems and Early Treatment Response to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents. Child Psychiatry Hum Dev 2022; 53:582-598. [PMID: 33733398 DOI: 10.1007/s10578-021-01151-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
The Top Problems assessment is an idiographic measure of client concerns that may allow clinicians to identify early treatment response. Few studies have examined early response to evidence-based therapies using Top Problems. We collected weekly Top Problems ratings from 95 youth with emotional disorders who received treatment using the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/UP-A). We assessed Top Problems rating change from session 1 to session 4, the role of pre-treatment variables in early Top Problems rating change, and the role of early Top Problems rating change in post-treatment symptom outcomes. Top Problems ratings decreased significantly from session 1 to session 4. Younger child age and higher parent cognitive flexibility were associated with early Top Problems improvement. Controlling for pre-treatment, early Top Problems rating change did not explain the variance in post-treatment outcomes. Future research should examine Top Problems trajectories over treatment course.
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Affiliation(s)
- Lauren Milgram
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Niza A Tonarely
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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13
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Gardiner F, Middleton J, Perera S, Gunner M, Churilov L, Coleman M, Poole L. Cohort study comparison of Mental Health and Wellbeing Services delivered by The Royal Flying Doctor Service, across Far North and Central West Queensland. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100385. [PMID: 35540562 PMCID: PMC9079348 DOI: 10.1016/j.lanwpc.2022.100385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Understanding cultural differences between geographical regions is essential in delivering culturally appropriate healthcare. We aimed to describe the characteristics and outcomes of diverse clients using the Far North Mental Health and Wellbeing Service (FNS) and the Central West Health and Wellbeing Service (CWS). Methods We conducted a cohort study within Queensland, Australia, on all clients who received a mental health therapy session at either the FNS or the CWS. Patient data was prospective data collected form July 2019 to December 2020. Findings There were1202 clients, with a median number of individual contacts per-client of 3.0 (IQR 2.0-6.0). There was 428 (35.6% 95% CI 32.90-38.39) males and 772 (64.2% 95% CI 61.44-66.94) females with a median age across the genders of 38.0 (IQR 28.0-51.0). There was 505 (42.0% 95% CI 39.20-44.86) identifying as Indigenous and 697 (58.0% 95% CI 55.14-60.80) as non-Indigenous Australians. The FNS had a significantly higher proportion of Indigenous clients (n=484; 54.8% 95% CI 51.46-58.13) as compared to the CWS (n=21; 6.6% 95% CI 4.12-9.89). Of the 1202 clients, 946 (78.7% 95% CI 76.28-80.99) had a socio-economic classification of ‘most disadvantaged’, consisting of 740 (83.8%) clients from the FNS and 206 (64.6%) clients from the CWS. The majority of presentations were for neurotic, stress-related and somatoform disorders (n=568; 47.3%), followed by mood affective disorders (n=310; 25.8%). The overall number of treatments strategies employed was 10798, equalling a median of 6.0 (IQR 4.0-9.0) strategies per-client, with the leading strategies being counselling/psychosocial (n=1394; 12.9%), reflective listening (n=1191; 11.0%), and strengths based reasoning (n=1116; 10.3%). There were 511 (42.5%) clients who completed the Kessler Psychological Distress Scale (K10/K5), with 493 (41.0%) clients not offered as deemed not culturally appropriate by the treating team. The mean initial K10/K5 score was 23.7 (SD 9.4) which significantly decreased (p<0.001) to 18.0 (SD 10.0) at final consultation. Interpretation This study highlighted client socioeconomic differences between two geographically remote mental health services. It is essential that services are regionally co-designed to ensure cultural appropriateness. Funding No funding to declare.
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14
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Lutz W, Schwartz B, Delgadillo J. Measurement-Based and Data-Informed Psychological Therapy. Annu Rev Clin Psychol 2021; 18:71-98. [PMID: 34910567 DOI: 10.1146/annurev-clinpsy-071720-014821] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Outcome measurement in the field of psychotherapy has developed considerably in the last decade. This review discusses key issues related to outcome measurement, modeling, and implementation of data-informed and measurement-based psychological therapy. First, an overview is provided, covering the rationale of outcome measurement by acknowledging some of the limitations of clinical judgment. Second, different models of outcome measurement are discussed, including pre-post, session-by-session, and higher-resolution intensive outcome assessments. Third, important concepts related to modeling patterns of change are addressed, including early response, dose-response, and nonlinear change. Furthermore, rational and empirical decision tools are discussed as the foundation for measurement-based therapy. Fourth, examples of clinical applications are presented, which show great promise to support the personalization of therapy and to prevent treatment failure. Finally, we build on continuous outcome measurement as the basis for a broader understanding of clinical concepts and data-driven clinical practice in the future. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany;
| | - Brian Schwartz
- Department of Psychology, University of Trier, Trier, Germany;
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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15
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Freins à l’abord des troubles du comportement alimentaire en médecine générale. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Van Wert MJ, Malik M, Memel B, Moore R, Buccino D, Hackerman F, Kumari S, Everett A, Narrow W. Provider perceived barriers and facilitators to integrating routine outcome monitoring into practice in an urban community psychiatry clinic: A mixed-methods quality improvement project. J Eval Clin Pract 2021; 27:767-775. [PMID: 32790131 DOI: 10.1111/jep.13457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Although mental health clinics are under increasing pressure to demonstrate value and routine outcome monitoring (ROM) has become a mandated component of care, providers have been slow to adopt ROM into practice, with some estimating that less than 20% of mental health clinicians use it consistently in the United States. This article explores perceived barriers and facilitators to integrating ROM into practice among clinicians and administrators in a large urban US community psychiatry clinic. METHOD One hundred and thirty-eight clinical and administrative staff were administered an anonymous web-based survey to elicit attitudes towards ROM. Responses were summarized descriptively and qualitatively synthesized into a conceptual model using inductive thematic analysis. RESULTS Common barriers to integration included insufficient time to collect and/or use measures, not knowing what measures to use, measures being difficult to access, and insufficient training. Facilitators included increased access/ease of use, training and support, measure relevance/validity, and accountability. CONCLUSIONS In order for psychiatry clinics to successfully implement ROM into practice, they must diagnose organization-side barriers and translate this knowledge into actionable quality improvement initiatives ranging from the infrastructural to the cultural.
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Affiliation(s)
- Michael J Van Wert
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Mansoor Malik
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Brenda Memel
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Ryan Moore
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Daniel Buccino
- Broadway Center for Addiction, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Florence Hackerman
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Suneeta Kumari
- Hackensack Meridian Health, Ocean Medical Center, Brick, New Jersey, USA
| | - Anita Everett
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - William Narrow
- Community Psychiatry Program, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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17
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Validation of a novel online depression symptom severity rating scale: the R8 Depression. Health Qual Life Outcomes 2021; 19:163. [PMID: 34118932 PMCID: PMC8196428 DOI: 10.1186/s12955-020-01654-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND An automated web-based assessment and monitoring system ( www.psynary.com ) has been developed to assist non-specialist clinicians in managing common mood and anxiety disorders. Psynary promotes the use of standardised outcome measures to assess symptom severity and optimise treatments with the aim of improving outcomes and enabling faster recovery. This paper analyses the results from two parallel studies in New Zealand and Japan (OptiMA-1 NZ and Japan) to assess the validity of the R8 Depression scale, one of the system's core outcome measures. METHODS Clinical samples were recruited from a public secondary care and a private psychiatry clinic. Participants completed the outcome measures for the study via the online Psynary system. The R8 Depression scale is a 30-item questionnaire which includes all symptom domains covered in the ICD-10 classification of depression. The Patient Health Questionnaire (PHQ-9) was completed at the same time points as the R8 Depression, with a smaller sample also completing a paper-based Quick Inventory of Depressive Symptomatology (QIDS-SR16). Internal validity was quantified via Cronbach's alpha and Guttman lower bounds method. External validation against the PHQ-9 and QIDS used the Pearson's and Kendall's correlation coefficients. Severity categories were set using a multivariate regression model. RESULTS 270 patients participated in the study and completed a maximum of 1 baseline and 5 reviews within a 90-day period, giving a total of 1124 assessments with the PHQ-9 also being completed in 1053 of these assessments. R8 Depression normative data was also collected from 204 non-clinical volunteers with 187 of these also completing the PHQ9. Internal reliability scores were all higher than 0.9 (n = 1328). There was overall good external validity when comparing the R8 Depression to the PHQ-9, with a correlation of 0.91 for the combined normative and clinical samples (n = 1240). CONCLUSIONS The R8 Depression has been developed as a patient-rated outcome measure for depression for administration on an online system called "Psynary". It has high internal and external validity against current widely used scales. Further work is underway to determine the sensitivity to change of the R8 Depression.
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18
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Rancans E, Dombi ZB, Mátrai P, Barabássy Á, Sebe B, Skrivele I, Németh G. The effectiveness and safety of cariprazine in schizophrenia patients with negative symptoms and insufficient effectiveness of previous antipsychotic therapy: an observational study. Int Clin Psychopharmacol 2021; 36:154-161. [PMID: 33560040 PMCID: PMC8011502 DOI: 10.1097/yic.0000000000000351] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
The aim of the study was to examine the effectiveness and safety of cariprazine in routine psychiatric settings on schizophrenia patients with negative symptoms who have been treated with antipsychotics previously but without sufficient success. This was an open-label, flexible-dose, 16-week, observational study in Latvia. The primary outcome measure was an array of anamnesis-based clinical questions on schizophrenia symptoms rated on a seven-point scale. Other outcome measurements were the clinical global impression improvement (CGI-I) and severity (CGI-S) scales. Safety parameters included spontaneous reports of adverse events and specific assessments of extrapyramidal side-effects. A mixed model for repeated measures was fit to the data to evaluate the mean change from baseline for all visits. A total of 116 patients enrolled in the study (completion: 83%). Change from baseline to termination in symptom control was statistically significant (-7.3; P < 0.001), with the most improvement in negative symptoms (-6.3; P < 0.001). Over 70% of patients improved minimally or much based on the CGI-I scores at the final visit, and the CGI-S scores indicated an overall improvement in severity from moderately to mildly ill. 40% of patients experienced treatment-emergent adverse events. Over 70% of doctors were satisfied with the effectiveness and tolerability of cariprazine. Cariprazine significantly improved negative symptoms in schizophrenia patients.
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Affiliation(s)
- Elmars Rancans
- Department of Psychiatry and Addiction Disorders, Riga Stradins University, Riga, Latvia
| | | | - Péter Mátrai
- Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | | | - Barbara Sebe
- Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | - Iveta Skrivele
- Representative Office of Latvia, Gedeon Richter Plc., Marupe, Latvia
| | - György Németh
- Medical Division, Gedeon Richter Plc., Budapest, Hungary
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19
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Pelizza L, Poletti M, Azzali S, Garlassi S, Scazza I, Paterlini F, Chiri LR, Pupo S, Raballo A. Subjective experience of social cognition in young people at Ultra-High Risk of psychosis: a 2-year longitudinal study. Nord J Psychiatry 2021; 75:97-108. [PMID: 32762506 DOI: 10.1080/08039488.2020.1799430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Impairments in SC have been reported in people at Ultra-High Risk (UHR) of psychosis exclusively using neurocognitive tasks. The aims of this study are (1) to assess subjective experience of SC in adolescent and young adult community help-seekers identified through UHR criteria, (2) to explore significant associations of SC with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally the SC stability after a 2-year follow-up period. Methods: Participants (97 UHR, 141 First-Episode Psychosis [FEP], and 98 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the GEOPTE scale of social cognition for psychosis. Within the UHR group, a multiple linear regression analysis (with GEOPTE scores as independent variables and CAARMS dimension subscores and treatment measures as dependent variables) was also performed across the 2-year longitudinal design. Results: In comparison with non-UHR/FEP, both UHR and FEP subjects showed significantly higher GEOPTE scores. Both after 12 and 24 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE SC subscore. In the UHR group, GEOPTE scores showed significant positive correlations with general psychopathology, positive and negative symptoms. Regression analysis showed a significant contribution of SC in predicting baseline social isolation, impaired role functioning, and general psychopathology. After 1 year of follow-up, improvement in SC was predicted by the number of psychotherapy sessions and lower doses of antipsychotics. Conclusions: SC deficits are prominent in UHR individuals and are similar in severity to those of FEP patients. However, they tend to decrease over time along with the delivery of targeted, specialized interventions for early psychosis.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Pupo
- Service of Anesthesiology and Resuscitaton, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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20
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Pelizza L, Poletti M, Azzali S, Garlassi S, Scazza I, Paterlini F, Chiri LR, Pupo S, Raballo A. Subjective experience of social cognition in adolescents at ultra-high risk of psychosis: findings from a 24-month follow-up study. Eur Child Adolesc Psychiatry 2020; 29:1645-1657. [PMID: 32016572 DOI: 10.1007/s00787-020-01482-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population. Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period. Participants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13-18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis. In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE "Social Cognition" subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms. Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy. .,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Strada del Quartiere n.2, 43100, Parma, PR, Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy.,Department of Primary Care, Azienda USL di Parma, Strada del Quartiere n.2, 43100, Parma, PR, Italy
| | - Simona Pupo
- Service of Anesthesiology and Resuscitaton, Azienda Ospedaliera-Universitaria di Parma, Via Gramsci n.1, 43100, Parma, PR, Italy.,Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Piazzale Lucio Severi n.1, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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21
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Ellison WD. An Initial Study of Practicing Psychologists' Views of the Utility of Ecological Momentary Assessment for Difficult Psychotherapy Cases. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:597-607. [PMID: 33047277 DOI: 10.1007/s10488-020-01093-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/22/2023]
Abstract
Ecological momentary assessment (EMA) is a burgeoning area of research, and several clinical applications of the resulting data have been identified by researchers, suggesting potential benefit to psychotherapy practice. However, practitioners often do not use traditional empirically-supported tools for diagnosis and outcome monitoring (e.g., validated interview measures and questionnaires). Thus, it is not clear how readily practitioners will take up newer technology-enhanced assessment methods, despite current enthusiasm among researchers. The current study aimed to explore the perceived usefulness of EMA-based tools for clinical assessment and outcome monitoring of difficult psychotherapy cases, as well as to identify correlates of attitudes about the usefulness of these tools. Clinical psychologists in active therapy practice with adults (n = 375) completed an internet survey including the Attitudes toward Standardized Assessment scale and the Attitudes toward Standardized Assessment Scales-Monitoring and Feedback. Respondents characterized their current diagnostic and outcome monitoring practices and rated how helpful they would find several assessment and outcome monitoring resources for a difficult case, including both traditional instruments and EMA-based methods. EMA-based tools had lower perceived usefulness than existing instruments. Attitudes toward standardized assessment and outcome monitoring predicted the perceived utility of these methods, as did several professional variables. Practicing psychologists may not adopt EMA for clinical assessment more readily than traditional assessment tools. Recommendations for facilitating the uptake of new technologies by psychotherapists are offered.
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Affiliation(s)
- William D Ellison
- Department of Psychology, Trinity University, One Trinity Place, San Antonio, TX, 78212, USA.
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22
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Demyttenaere K, Jaspers L. Trends in (not) using scales in major depression: A categorization and clinical orientation. Eur Psychiatry 2020; 63:e91. [PMID: 32962793 PMCID: PMC7681155 DOI: 10.1192/j.eurpsy.2020.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Standard depression rating scales like the Hamilton Depression Rating Scale and the Montgomery–Åsberg Depression Rating Scale were developed more than 40 years ago. They are mandatory in clinical trials but are for a variety of reasons seldom used in clinical practice. Moreover, most clinicians are less familiar with more recent trends or with some dilemmas in assessment tools for major depression. Methods Narrative review. Results Asssessment tools can be observer-rating or self-rating scales, disease-specific or non–disease-specific scales, subjective scales or objective lab assessments, standard questionnaires or experience sampling methods. An overarching question is to what degree current assessment methods really address the individual patient’s needs and treatment expectations. Conclusions The present paper aims to offer a framework for understanding the current trends in assessment tools that can orientate and guide the clinician.
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Affiliation(s)
- Koen Demyttenaere
- Faculty of Medicine, Department of Neurosciences, Research Group Psychiatry and University Psychiatric Center, KU Leuven, Leuven, Belgium
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23
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Abstract
SUMMARYValue-based healthcare holds great potential to transform healthcare globally. This commentary reviews the historical milestones in its evolution and raises critical questions regarding how it should proceed.
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24
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Dinakaran D, Sreeraj VS, Venkatasubramanian G. Measurement based care in schizophrenia-Feasibility in routine clinical practice. Asian J Psychiatr 2020; 49:101954. [PMID: 32065965 DOI: 10.1016/j.ajp.2020.101954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/30/2019] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
Measurement based care (MBC) implies the utilization of structured objective scales/batteries in the assessment and monitoring of an illness. Patients with schizophrenia with heterogeneous presentation would potentially benefit better through MBC. Time constraints and additional work burden are frequently cited as barriers in implementing objective assessments. In this selective review, the authors discuss the available standard scales for assessment in schizophrenia, the advantages and disadvantages in implementing MBC and a feasible approach to overcome the barriers by adapting shorter versions of structured scales.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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25
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Bjaastad JF, Jensen-Doss A, Moltu C, Jakobsen P, Hagenberg H, Joa I. Attitudes toward standardized assessment tools and their use among clinicians in a public mental health service. Nord J Psychiatry 2019; 73:387-396. [PMID: 31322010 DOI: 10.1080/08039488.2019.1642383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre-post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.
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Affiliation(s)
- Jon Fauskanger Bjaastad
- Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre , Bergen , Norway
| | | | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde , Førde , Norway
| | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway.,Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Heine Hagenberg
- Division of Psychiatry, District General Hospital of Fonna , Haugesund , Norway
| | - Inge Joa
- TIPS - Network for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital , Stavanger , Norway.,The Interprofessional Network for Medical Sciences, Department of Public Health, Faculty of Health Sciences, University of Stavanger , Stavanger , Norway
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26
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Zimmerman M, Balling C, Chelminski I, Dalrymple K. Symptom presence versus symptom intensity in understanding the severity of depression: Implications for documentation in electronic medical records. J Affect Disord 2019; 256:344-347. [PMID: 31207558 DOI: 10.1016/j.jad.2019.05.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/28/2018] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data mining efforts have been applied to research data bases to develop statistical models for predicting outcomes. Electronic medical records have the potential to enable efforts to apply statistical techniques to mine large clinical data bases. Of course, such prediction algorithms will only be as good as the data that is available to input. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is how much information might be gained from dimensional ratings of symptom severity over and above that which is accounted for when determining symptom presence. Such results could have implications for how medical record documentation should be established. METHODS Patients were evaluated with a semi-structured interview, and the presence of each symptom of major depressive disorder (MDD) was recorded. Patients were also rated on the Clinical Global Index of Severity (CGI-S). RESULTS A multiple regression analysis entering the presence of MDD symptoms as predictors of the CGI had a cumulative R2 of 0.26. A multiple regression analysis entering all symptom severity ratings as predictors of the CGI had a cumulative R2 of 0.40. LIMITATIONS The study was based on patients presenting for outpatient treatment to a single clinical practice. Symptoms that are not diagnostic criteria for MDD were not examined. DISCUSSION Research institutions interested in using data mining statistical approaches of electronic medical records should consider having the clinicians rate whether symptoms are mild, moderate or severe and not just whether they are present or absent.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI. Reprint requests to Mark Zimmerman, MD, 146 West River Street, Providence, RI 02904, United States.
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI. Reprint requests to Mark Zimmerman, MD, 146 West River Street, Providence, RI 02904, United States
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI. Reprint requests to Mark Zimmerman, MD, 146 West River Street, Providence, RI 02904, United States
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI. Reprint requests to Mark Zimmerman, MD, 146 West River Street, Providence, RI 02904, United States
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Newman-Taylor K, Maguire T, Bowen A. Why are we not measuring what matters in mental health in the UK? The case for routine use of recovery outcome measures. Perspect Public Health 2019; 139:181-183. [PMID: 31251132 DOI: 10.1177/1757913919851414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Lin CH, Park C, McIntyre RS. Early improvement in HAMD-17 and HAMD-7 scores predict response and remission in depressed patients treated with fluoxetine or electroconvulsive therapy. J Affect Disord 2019; 253:154-161. [PMID: 31035216 DOI: 10.1016/j.jad.2019.04.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/13/2019] [Accepted: 04/21/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Compared to the 17-Item Hamilton Rating Scale for Depression (HAMD-17), the 7-Item Hamilton Rating Scale for Depression (HAMD-7) would be more practical for use in busy clinical settings. Herein, we aim to evaluate (1) whether the HAMD-7 is a reliable and valid measure that is sensitive to changes in depressive symptoms, and (2) whether early improvement of depressive symptoms, as measured by the HAMD-7, is capable of predicting response and remission in patients with major depressive disorder (MDD) during acute treatment with fluoxetine or electroconvulsive therapy (ECT). METHODS This is a post-hoc analysis of two clinical trials in MDD. Internal consistency, validity, and sensitivity-to-change of the HAMD-17 and HAMD-7 were compared during acute treatment and at 3-month follow-up. Receiver operating characteristic analyses were used to evaluate the discriminative capacity of the HAMD-17 and HAMD-7. RESULTS The HAMD-7 is a reliable and valid measure that is sensitive to changes in depressive symptoms. Early improvement, as measured by either the HAMD-17 or HAMD-7, was capable of predicting response and remission to acute treatment with fluoxetine or ECT with good discriminative capacity. LIMITATIONS This is a post-hoc analysis of two open-label clinical trials with limited sample sizes. All patients were Taiwanese, which limits the generalizability of our results. CONCLUSIONS HAMD-7 is a clinically useful measure that is capable of detecting early improvement of depressive symptoms. The HAMD-7 may have the potential to inform clinical assessment as part of measurement-based care.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Caroline Park
- Institute of Medical Science, University of Toronto, Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation (BCDF), Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
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29
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Damman OC, Verbiest MEA, Vonk SI, Berendse HW, Bloem BR, de Bruijne MC, Faber MJ. Using PROMs during routine medical consultations: The perspectives of people with Parkinson's disease and their health professionals. Health Expect 2019; 22:939-951. [PMID: 31199574 PMCID: PMC6803413 DOI: 10.1111/hex.12899] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The use of patient-reported outcomes measures (PROMs), such as quality of life or symptoms like pain or fatigue, is increasingly embraced within patient-centred care and shared decision making. OBJECTIVES To investigate: (a) how patients and health professionals think about using PROMs during routine medical consultations; (b) for which purpose(s), patients and health professionals want to use PROMs during those consultations; and (c) how patients interpret PROMs information presented in various formats. People with Parkinson's disease and their health professionals served as case example. METHODS We performed semi-structured interviews with patients (N = 13) and professionals (N = 7 neurologists; N = 7 physiotherapists). We also used a survey in which patients (N = 115) were shown six figures displaying different information types. Presentation formats of this information varied (line/bar graphs). Interpretation by patients, perceived usefulness of information, attitude towards using information during routine medical consultations and (hypothetical) decisions were assessed. FINDINGS Patients and professionals were generally positive about using PROMs during medical consultations. Professionals stressed the opportunity to monitor changes in individual PROMs over time. Patients were primarily positive about aggregated PROMs to make treatment decisions. This information was also most often interpreted correctly, especially when presented through a line graph (90.1% correct). Professionals thought patients should take the initiative in discussing PROMs, whereas patients thought professionals should do so. CONCLUSION/DISCUSSION When used in routine medical consultations, PROMs seem to have potential to support shared decision making and facilitate patient-professional communication. However, training seems needed for both patients and professionals to facilitate actual discussion and proper interpretation.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein E A Verbiest
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Suzanne I Vonk
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk W Berendse
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjan J Faber
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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30
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Jensen-Doss A, Smith AM, Becker-Haimes EM, Mora Ringle V, Walsh LM, Nanda M, Walsh SL, Maxwell CA, Lyon AR. Individualized Progress Measures Are More Acceptable to Clinicians Than Standardized Measures: Results of a National Survey. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:392-403. [PMID: 29143173 DOI: 10.1007/s10488-017-0833-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite research supporting measurement-based care grounded in standardized progress measures, such measures are underutilized by clinicians. Individualized measures of client-specific targets present an alternative, but little is known about their acceptability or use. We compared attitudes toward and use of standardized and individualized progress measures in a national sample of 504 clinicians. Clinicians reported neutral to positive attitudes toward both types of measures, but strongly preferred and were more likely to use individualized measures. Clinician attitudes, theoretical orientation, and work setting predicted assessment preferences and practices. Implications for dissemination and implementation of measurement-based care are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Ashley M Smith
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.,University of California, Los Angeles, USA
| | | | - Vanesa Mora Ringle
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Lucia M Walsh
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Monica Nanda
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Colleen A Maxwell
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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31
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Cerimele JM, Goldberg SB, Miller CJ, Gabrielson SW, Fortney JC. Systematic Review of Symptom Assessment Measures for Use in Measurement-Based Care of Bipolar Disorders. Psychiatr Serv 2019; 70:396-408. [PMID: 30717645 PMCID: PMC6543835 DOI: 10.1176/appi.ps.201800383] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Utilization of measurement-based care (MBC) for bipolar disorders is limited, in part because of uncertainty regarding the utility of available measures. The aim of this study was to synthesize the literature on patient-reported and clinician-observed measures of symptoms of bipolar disorder and the potential use of these measures in MBC. METHODS A systematic review of multiple databases (PubMed, Embase, PsycINFO, Cochrane Library, and other gray literature) was conducted in June 2017 to identify validated measures. Data on the psychometric properties of each measure were extracted and used to assess the measure's clinical utility on the basis of established guidelines. RESULTS Twenty-eight unique measures were identified in 39 studies, including four patient-reported and six clinician-observed measures assessing manic symptoms, three patient-reported and five clinician-observed measures of depressive symptoms, and six patient-reported and four clinician-observed measures of both symptom types. Patient-reported measures with the highest clinical utility included the Altman Self-Rating Mania Scale for assessment of manic symptoms, the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) (depressive symptoms), and the Internal State Scale (both types). Highly rated clinician (C)-observed scales were the Bech-Rafaelsen Mania Rating Scale (mania), the QIDS-C (depressive symptoms), and the Bipolar Inventory of Symptoms Scale (both types). CONCLUSIONS Suitable choices are available for MBC of bipolar disorders. The choice of a measure could be informed by clinical utility score and may also depend on how clinicians or practices weigh each category of the clinical utility scale and on the clinical setting and presenting problem.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - Simon B Goldberg
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - Christopher J Miller
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - Stephen W Gabrielson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Cerimele, Fortney); U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Center of Innovation, Seattle (Fortney); Department of Counseling Psychology, University of Wisconsin-Madison (Goldberg); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Miller); M. B. Ketchum Memorial Library, Marshall B. Ketchum University, Fullerton, California (Gabrielson)
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Implementing Outcome-based Care in Pediatric Psychiatry: Early Results and Overcoming Barriers. Pediatr Qual Saf 2019; 4:e132. [PMID: 30937414 PMCID: PMC6426486 DOI: 10.1097/pq9.0000000000000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Poor utilization of standardized outcome measures for monitoring patient care and progress in mental health services is evident. The objective of this work was to implement computerized diagnostic and history assessments for outpatient mental health visits in the ambulatory psychiatric clinic of a large pediatric health system. Methods: A computerized assessment system was created for the iPad to administer and score a series of validated diagnostics before new patient and follow-up appointments with a psychiatry provider. Outcome measures were a percentage of completed assessments, provider satisfaction, and patient satisfaction. Results: Across all outpatient psychiatry clinics, screener completion rate for new patients increased from 0% to 90% within 1 year of implementation and sustained within 3σ process control limits for 2 years. Return visit assessment completion increased from 0% to 80%. The most substantial completion rate increase was related to scheduling assessment time as part of the visit. Assessment of provider and patient satisfaction through surveys before and after the implementation showed 94% of providers felt that visit efficiency had improved, and overall opinion of the system was highly positive. Patients also reported high satisfaction with the assessment process (4.1 on Likert scale 0–5, 5 = very positive). Conclusions: This quality improvement program demonstrates strategies for overcoming barriers to the use of standardized assessments in outpatient psychiatry. We show that a large pediatric mental health system can achieve systematic outcome data collection with minimal disruption to routine clinical care.
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Zimmerman M, Kerr S, Kiefer R, Balling C, Dalrymple K. What is anxious depression? Overlap and agreement between different definitions. J Psychiatr Res 2019; 109:133-138. [PMID: 30530208 DOI: 10.1016/j.jpsychires.2018.11.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 01/25/2023]
Abstract
Anxiety is common in depressed patients. However, a problem with the research on the significance of anxiety in depressed patients is that anxiety has been characterized in different ways. Little research has examined the concordance and overlap between the various definitions of anxious depression. With research on the DSM-5 anxious distress specifier just beginning, it will be important to understand how defining anxious depression according to DSM-5 agrees with previously studied definitions. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined the association between the DSM-5 anxious distress specifier and 6 other approaches towards defining anxious depression. Three hundred thirty-one patients with a principal diagnosis of major depressive disorder were evaluated with semi-structured diagnostic interviews. The mean number of anxious depression definitions met was 4.7 (SD = 2.1). Only 4.2% (n = 14) of the 331 patients did not meet any anxious depression definition, and 28.1% (n = 93) met all 7 definitions. The level of agreement between the definitions was significant, albeit modest (median kappa = .28). The modest association between the different definitions of anxious depression suggests that the results based on one approach towards subtyping may not generalize to the DSM-5 anxious distress specifier. It therefore cannot be assumed that the DSM-5 anxious distress specifier is valid just because other definitions of anxious depression have been shown to be valid.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, United States.
| | - Sophie Kerr
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, United States
| | - Reina Kiefer
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, United States
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, United States
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, United States
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34
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Cho E, Wood PK, Taylor EK, Hausman EM, Andrews JH, Hawley KM. Evidence-Based Treatment Strategies in Youth Mental Health Services: Results from a National Survey of Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:71-81. [PMID: 30209703 PMCID: PMC7357714 DOI: 10.1007/s10488-018-0896-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous surveys indicate infrequent use of evidence-based treatment (EBT) manuals in usual care youth mental health, but the extent to which providers use core and common EBT strategies and what contextual factors impact EBT strategy implementation need further study. In a national, multidisciplinary survey of 1092 youth-serving providers, providers reported regular use of many EBT strategies. Provider learning theory orientation, more recent degree, more standardized and ongoing assessment use, more positive attitudes toward innovation and evidence, fewer low-income clients, and perceptions that their agency valued quality care and provided fewer training resources predicted more frequent EBT strategy use.
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Affiliation(s)
- Evelyn Cho
- University of Missouri, Columbia, MO, 65211, USA.
| | | | - Erin K Taylor
- University of Missouri, Columbia, MO, 65211, USA
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Estee M Hausman
- University of Missouri, Columbia, MO, 65211, USA
- Stony Brook University, Stony Brook, USA
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35
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Downs J, Dean H, Lechler S, Sears N, Patel R, Shetty H, Hotopf M, Ford T, Kyriakopoulos M, Diaz-Caneja CM, Arango C, MacCabe JH, Hayes RD, Pina-Camacho L. Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure. Schizophr Bull 2019; 45:69-79. [PMID: 29370404 PMCID: PMC6293208 DOI: 10.1093/schbul/sbx197] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The prevalence of negative symptoms (NS) at first episode of early-onset psychosis (EOP), and their effect on psychosis prognosis is unclear. In a sample of 638 children with EOP (aged 10-17 y, 51% male), we assessed (1) the prevalence of NS at first presentation to mental health services and (2) whether NS predicted eventual development of multiple treatment failure (MTF) prior to the age of 18 (defined by initiation of a third trial of novel antipsychotic due to prior insufficient response, intolerable adverse-effects or non-adherence). Data were extracted from the electronic health records held by child inpatient and community-based services in South London, United Kingdom. Natural Language Processing tools were used to measure the presence of Marder Factor NS and antipsychotic use. The association between presenting with ≥2 NS and the development of MTF over a 5-year period was modeled using Cox regression. Out of the 638 children, 37.5% showed ≥2 NS at first presentation, and 124 (19.3%) developed MTF prior to the age of 18. The presence of NS at first episode was significantly associated with MTF (adjusted hazard ratio 1.62, 95% CI 1.07-2.46; P = .02) after controlling for a number of potential confounders including psychosis diagnostic classification, positive symptoms, comorbid depression, and family history of psychosis. Other factors associated with MTF included comorbid autism spectrum disorder, older age at first presentation, Black ethnicity, and family history of psychosis. In EOP, NS at first episode are prevalent and may help identify a subset of children at higher risk of responding poorly to antipsychotics.
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Affiliation(s)
- Johnny Downs
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK,South London and Maudsley NHS Foundation Trust, UK,Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, UK
| | - Harry Dean
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Suzannah Lechler
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Nicola Sears
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Rashmi Patel
- South London and Maudsley NHS Foundation Trust, UK,Department of Psychosis Studies, Institute of Psychiatry Psychology Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | | | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK,South London and Maudsley NHS Foundation Trust, UK
| | | | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, UK,Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, UK,Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Covadonga M Diaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Spain
| | - James H MacCabe
- South London and Maudsley NHS Foundation Trust, UK,Department of Psychosis Studies, Institute of Psychiatry Psychology Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Richard D Hayes
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, UK,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Spain,To whom correspondence should be addressed; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Ibiza 43, 28009 Madrid, Spain; tel: +34-914265005, fax: +34-914265004, e-mail:
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36
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Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G, Kroenke K. Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry 2018; 76:324-335. [PMID: 30566197 PMCID: PMC6584602 DOI: 10.1001/jamapsychiatry.2018.3329] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. OBSERVATIONS Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
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Affiliation(s)
- Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Meredith Boyd
- Department of Psychology, UCLA (University of California, Los
Angeles)
| | - Ajeng Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Minnesota
| | - Elena Navarro
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University,
Bloomington
| | | | - Mira Hoffman
- Department of Psychology, West Virginia University,
Morgantown
| | - Kelli Scott
- School of Public Health, Brown University, Providence, Rhode
Island
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Peabody
College, Vanderbilt University, Nashville, Tennessee
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute,
Seattle
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37
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Young AS, Cohen AN, Hamilton AB, Hellemann G, Reist C, Whelan F. Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia. J Behav Health Serv Res 2018; 46:129-139. [PMID: 30465314 DOI: 10.1007/s11414-018-9641-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
"Enhancing QUality of Care In Psychosis" (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5-3.6; χ2 = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients' final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.
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Affiliation(s)
- Alexander S Young
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA. .,University of California, Los Angeles, CA, USA. .,UCLA Center for Health Services, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, 90024, USA. .,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.
| | - Amy N Cohen
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Alison B Hamilton
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Gerhard Hellemann
- University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Christopher Reist
- Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.,Long Beach Veterans Healthcare System, Long Beach, CA, USA.,University of California, Irvine, CA, USA
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Wray LO, Ritchie MJ, Oslin DW, Beehler GP. Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation. BMC Health Serv Res 2018; 18:753. [PMID: 30285718 PMCID: PMC6171308 DOI: 10.1186/s12913-018-3493-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mental health care lags behind other forms of medical care in its reliance on subjective clinician assessment. Although routine use of standardized patient-reported outcome measures, measurement-based care (MBC), can improve patient outcomes and engagement, clinician efficiency, and, collaboration across care team members, full implementation of this complex practice change can be challenging. This study seeks to understand whether and how an intensive facilitation strategy can be effective in supporting the implementation of MBC. Implementation researchers partnering with US Department of Veterans Affairs (VA) leaders are conducting the study within the context of a national initiative to support MBC implementation throughout VA mental health services. This study will focus specifically on VA Primary Care-Mental Health Integration (PCMHI) programs. METHODS A mixed-methods, multiple case study design will include 12 PCMHI sites recruited from the 23 PCMHI programs that volunteered to participate in the VA national initiative. Guided by a study partnership panel, sites are clustered into similar groups using administrative metrics. Site pairs are recruited from within these groups. Within pairs, sites are randomized to the implementation facilitation strategy (external facilitation plus QI team) or standard VA national support. The implementation strategy provides an external facilitator and MBC experts who work with intervention sites to form a QI team, develop an implementation plan, and, identify and overcome barriers to implementation. The RE-AIM framework guides the evaluation of the implementation facilitation strategy which will utilize data from administrative, medical record, and primary qualitative and quantitative sources. Guided by the iPARIHS framework and using a mixed methods approach, we will also examine factors associated with implementation success. Finally, we will explore whether implementation of MBC increases primary care team communication and function related to the care of mental health conditions. DISCUSSION MBC has significant potential to improve mental health care but it represents a major change in practice. Understanding factors that can support MBC implementation is essential to attaining its potential benefits and spreading these benefits across the health care system.
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Affiliation(s)
- Laura O. Wray
- Department of Veterans Affairs, VA Center for Integrated Healthcare, 3495 Bailey Avenue, Buffalo, NY 14215 USA
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main Street, Suite 6186, Buffalo, NY 14203 USA
| | - Mona J. Ritchie
- Department of Veterans Affairs, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, 2200 Ft Roots Dr, Bdg 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
| | - David W. Oslin
- VISN 4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104 USA
- Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, 3900 Chestnut St, Philadelphia, PA 19104 USA
| | - Gregory P. Beehler
- Department of Veterans Affairs, VA Center for Integrated Healthcare, 3495 Bailey Avenue, Buffalo, NY 14215 USA
- Schools of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, 955 Main Street, Buffalo, NY 14214 USA
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Joeris A, Knoll C, Kalampoki V, Blumenthal A, Gaskell G. Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons. BMJ Open 2018; 8:e020629. [PMID: 29895649 PMCID: PMC6009470 DOI: 10.1136/bmjopen-2017-020629] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs. DESIGN Online survey. PARTICIPANTS Surgeons who are members of the AO Foundation. MEASURES Participants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ2 tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage. RESULTS 1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine. CONCLUSIONS Our survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help.
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Affiliation(s)
- Alexander Joeris
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Christian Knoll
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Andrea Blumenthal
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - George Gaskell
- Department of Methodology, London School of Economics, London, UK
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40
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Tasma M, Roebroek LO, Liemburg EJ, Knegtering H, Delespaul PA, Boonstra A, Swart M, Castelein S. The development and evaluation of a computerized decision aid for the treatment of psychotic disorders. BMC Psychiatry 2018; 18:163. [PMID: 29859050 PMCID: PMC5984829 DOI: 10.1186/s12888-018-1750-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Routinely monitoring of symptoms and medical needs can improve the diagnostics and treatment of medical problems, including psychiatric. However, several studies show that few clinicians use Routine Outcome Monitoring (ROM) in their daily work. We describe the development and first evaluation of a ROM based computerized clinical decision aid, Treatment-E-Assist (TREAT) for the treatment of psychotic disorders. The goal is to generate personalized treatment recommendations, based on international guidelines combined with outcomes of mental and physical health acquired through ROM. We present a pilot study aimed to assess the feasibility of this computerized clinical decision aid in daily clinical practice by evaluating clinicians' experiences with the system. METHODS Clinical decision algorithms were developed based on international schizophrenia treatment guidelines and the input of multidisciplinary expert panels from multiple psychiatric institutes. Yearly obtained diagnostic (ROM) information of patients was presented to treating clinicians combined with treatment suggestions generated by the algorithms of TREAT. In this pilot study 6 clinicians and 16 patients of Lentis Psychiatric Institute used the application. Clinicians were interviewed and asked to fill out self-report questionnaires evaluating their opinions about ROM and the effectiveness of TREAT. RESULTS Six clinicians and 16 patients with psychotic disorders participated in the pilot study. The clinicians were psychiatrists, physicians and nurse-practitioners which all worked at least 8 years in mental health care of which at least 3 years treating patients with psychotic illnesses. All Clinicians found TREAT easy to use and would like to continue using the application. They reported that TREAT offered support in using diagnostic ROM information when drafting the treatment plans, by creating more awareness of current treatment options. CONCLUSION This article presents a pilot study on the implementation of a computerized clinical decision aid linking routine outcome monitoring to clinical guidelines in order to generate personalized treatment advice. TREAT was found to be feasible for daily clinical practice and effective based on this first evaluation by clinicians. However, adjustments have to be made to the system and algorithms of the application. The ultimate goal is to provide appropriate evidence based care for patients with severe mental illnesses.
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Affiliation(s)
- Magda Tasma
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lukas O. Roebroek
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands ,0000 0004 0407 1981grid.4830.fFaculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Edith J. Liemburg
- Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henderikus Knegtering
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Philippe A. Delespaul
- 0000 0001 0481 6099grid.5012.6Faculty of Psychiatry & Psychology, Maastricht University, Maastricht, The Netherlands ,Mondriaan Mental Health Trust, Heerlen-Maastricht, The Netherlands
| | - Albert Boonstra
- 0000 0004 0407 1981grid.4830.fFaculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Marte Swart
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stynke Castelein
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands ,0000 0004 0407 1981grid.4830.fFaculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
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41
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Treichler EBH, Spaulding WD. Provider-Associated Measurement Error in Routine Outcome Monitoring in Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:780-789. [PMID: 29550889 DOI: 10.1007/s10488-018-0861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite the strengths of routine outcome monitoring (ROM) in community mental health settings, there are a number of barriers to effective implementation of ROM, including measurement error due to provider factors (e.g., training level) and non-target client factors (i.e., client characteristics which have no meaningful relationship to the outcome of interest). In this study, ROM data from 80 client-provider dyads were examined for sources of variance due to provider factors and non-target client factors. Results indicated that provider factors and non-target client factors accounted for between 9.6 and 54% of the variance in the ROM measures. Our findings supported past research that provider characteristics impact ROM, and added the novel finding that client gender, age, diagnosis, and cognition also impact ROM. Methods to increase accuracy and utility of ROM in community mental health are discussed.
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Affiliation(s)
- Emily B H Treichler
- VA San Diego Healthcare System, VISN 22 MIRECC & University of California-San Diego, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
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42
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Antunes RP, Sales CMD, Elliott R. The clinical utility of the Personal Questionnaire (PQ): a mixed methods study. COUNSELLING PSYCHOLOGY QUARTERLY 2018. [DOI: 10.1080/09515070.2018.1439451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R. P. Antunes
- Department of Psychology, University of Évora, Évora, Portugal
| | - C. M. D. Sales
- Faculty of Psychology and Education Sciences at the University of Porto (FPCEUP), Center for Psychologyat the University of Porto (CPUP), Porto, Portugal
| | - R. Elliott
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, Scotland
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43
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Lin CH, Lin HS, Lin SC, Kuo CC, Wang FC, Huang YH. Early improvement in PANSS-30, PANSS-8, and PANSS-6 scores predicts ultimate response and remission during acute treatment of schizophrenia. Acta Psychiatr Scand 2018; 137:98-108. [PMID: 29280500 DOI: 10.1111/acps.12849] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE PANSS-8 and PANSS-6 are derived from the 30-item Positive and Negative Syndrome Scale (PANSS-30). We investigate whether PANSS-8 or PANSS-6 is a reliable, valid, sensitive to change measure, and scalable, and whether early improvement using them can predict response/remission. METHOD Data were from 3 trials for 270 schizophrenia inpatients receiving antipsychotics. Internal consistency, validity, sensitivity to change, and scalability using PANSS-30, PANSS-8, and PANSS-6 at each assessment were examined. Early improvement was defined as at least 20% reduction of PANSS-30, PANSS-8, or PANSS-6 scores at week 2. Response was defined as at least 40% reduction of PANSS-30 and remission as a score of PANSS-8 ≤ 3 on each item at endpoint. Receiver operating characteristic analysis was used to determine which rating scale had better discriminative capacity. RESULTS PANSS-8 and PANSS-6 showed acceptable internal consistency, were highly correlated with PANSS-30, and had sensitivity to change. PANSS-8 and PANSS-6 were scalable at each assessment, except for PANSS-6 at baseline. Early improvement using PANSS-8 or PANSS-6 had comparable predictive values with that of PANSS-30 for response/remission. CONCLUSION PANSS-8 and PANSS-6 are clinically useful measures. Early improvement, regardless of whether PANSS-30, PANSS-8, or PANSS-6 is used, is a statistically significant predictor of response/remission.
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Affiliation(s)
- C-H Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-S Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - S-C Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - C-C Kuo
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - F-C Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Y-H Huang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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44
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Delaffon V, Anwar Z, Noushad F, Ahmed AS, Brugha TS. Use of Health of the Nation Outcome Scales in psychiatry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.110.008029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryRoutine outcome measures are essential to chart individual patient progress and evaluate models of service provision. The Health of the Nation Outcome Scales (HoNOS) were commissioned by the Royal College of Psychiatrists as a simple, brief measure for this purpose. It is one of the most widely used outcome measures in mental health services globally and has been translated into at least seven languages. Its use has broadened beyond its original purpose and in several countries collection of HoNOS data is mandatory. We review 585 potential articles to chart the development and evolution of HoNOS, as well as its psychometric properties, qualitative attributes and uses in clinical practice and research. The potential barriers to implementation of HoNOS on a wide scale are considered and its future role in evaluating effectiveness and benchmarking of services are discussed.
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45
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Laugharne R, Shankar R. Quality standards for community mental health teams. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.108.022665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThere is an increasing requirement for mental health services to demonstrate the quality of care provided. We have developed a quality report of our local community mental health team in Cornwall and suggest quality measures that we believe are useful to patients and clinicians, and possible to implement without overwhelming busy team members. They include measures of satisfaction, accessibility, safe process and review, outcomes, evidence-based practice and staff performance. Different teams may need different standards but we hope this paper will stimulate discussion and debate.
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46
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Yeomans D, Taylor M, Currie A, Whale R, Ford K, Fear C, Hynes J, Sullivan G, Moore B, Burns T. Resolution and remission in schizophrenia: getting well and staying well. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.108.006411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryRemission is a new research outcome indicating long-term wellness. Remission not only sets a standard for minimal severity of symptoms and signs (resolution); it also sets a standard for how long symptoms and signs need to remain at this minimal level (6 months). Individuals who achieve remission from schizophrenia have better subjective well-being and better functional outcomes than those who do not. Research suggests that remission can be achieved in 20–60% of people with schizophrenia. There is some evidence of the usefulness of remission as an outcome indicator for clinicians, service users and their carers. This article reviews the literature on remission in schizophrenia and asks whether it could be a useful clinical standard of well-being and a foundation for functional improvement and recovery.
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Abstract
Aims and MethodA postal survey was conducted to gauge opinion of consultant psychiatrists in the west of Scotland with regard to consultant appraisal.ResultsWe received 158 responses to our survey (a response rate of 77%). The results showed mixed feelings about appraisal – for example, its purpose was felt to be about the development of consultants (72%) rather than the protection of patients (53%). Practical problems were highlighted, like the provision of accurate data and the amount of time spent on the preparation for appraisal.Participation in 360-degree appraisal was scant, and no consensus on the use of outcome measures was reached.ImplicationsMore work needs to be done on the appraisal process for it to gain the full confidence of the profession.
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48
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Zimmerman M, Walsh E, Friedman M, Boerescu DA, Attiullah N. Are self-report scales as effective as clinician rating scales in measuring treatment response in routine clinical practice? J Affect Disord 2018; 225:449-452. [PMID: 28858659 DOI: 10.1016/j.jad.2017.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/31/2017] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recent treatment guidelines have suggested that outcome should be measured in routine clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared three self-report scales of depressive symptoms and the two most widely used clinician administered scales in treatment studies in their sensitivity to change and evaluation of treatment response in depressed patients treated in routine practice. METHODS At baseline and 4-month follow-up 153 depressed outpatients with DSM-IV MDD completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology-Self-report version (QIDS-SR), and Patient Health Questionnaire (PHQ-9). The patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS). On each scale treatment response was defined as a 50% or greater reduction in scores from baseline. RESULTS While there were some differences in the percentage of patients considered to be responders on the different scales, a large effect size was found for each scale, with little variability amongst the scales. The level of agreement between the three self-report scales and the clinician rating scales was approximately the same LIMITATIONS: The present study was conducted in a single clinical practice in which the majority of the patients were white, female, and had health insurance. DISCUSSION When measuring outcome in clinical practice the magnitude of change in depressive symptoms is as great on self-report scales as on clinician rating scales.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States.
| | - Emily Walsh
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | - Michael Friedman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | - Daniela A Boerescu
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | - Naureen Attiullah
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
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49
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Benrimoh D, Fratila R, Israel S, Perlman K, Mirchi N, Desai S, Rosenfeld A, Knappe S, Behrmann J, Rollins C, You RP, Aifred Health Team T. Aifred Health, a Deep Learning Powered Clinical Decision Support System for Mental Health. THE NIPS '17 COMPETITION: BUILDING INTELLIGENT SYSTEMS 2018. [DOI: 10.1007/978-3-319-94042-7_13] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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50
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Jensen-Doss A, Haimes EMB, Smith AM, Lyon AR, Lewis CC, Stanick CF, Hawley KM. Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:48-61. [PMID: 27631610 PMCID: PMC5495625 DOI: 10.1007/s10488-016-0763-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Numerous trials demonstrate that monitoring client progress and using feedback for clinical decision-making enhances treatment outcomes, but available data suggest these practices are rare in clinical settings and no psychometrically validated measures exist for assessing attitudinal barriers to these practices. This national survey of 504 clinicians collected data on attitudes toward and use of monitoring and feedback. Two new measures were developed and subjected to factor analysis: The monitoring and feedback attitudes scale (MFA), measuring general attitudes toward monitoring and feedback, and the attitudes toward standardized assessment scales-monitoring and feedback (ASA-MF), measuring attitudes toward standardized progress tools. Both measures showed good fit to their final factor solutions, with excellent internal consistency for all subscales. Scores on the MFA subscales (Benefit, Harm) indicated that clinicians hold generally positive attitudes toward monitoring and feedback, but scores on the ASA-MF subscales (Clinical Utility, Treatment Planning, Practicality) were relatively neutral. Providers with cognitive-behavioral theoretical orientations held more positive attitudes. Only 13.9 % of clinicians reported using standardized progress measures at least monthly and 61.5 % never used them. Providers with more positive attitudes reported higher use, providing initial support for the predictive validity of the ASA-MF and MFA. Thus, while clinicians report generally positive attitudes toward monitoring and feedback, routine collection of standardized progress measures remains uncommon. Implications for the dissemination and implementation of monitoring and feedback systems are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Emily M Becker Haimes
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Ashley M Smith
- Child Division, Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Cara C Lewis
- University of Washington, Seattle, USA
- Indiana University, Bloomington, USA
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