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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tasma M, Liemburg EJ, Knegtering H, Delespaul PAEG, Boonstra A, Castelein S. Exploring the use of Routine Outcome Monitoring in the treatment of patients with a psychotic disorder. Eur Psychiatry 2017; 42:89-94. [PMID: 28314165 DOI: 10.1016/j.eurpsy.2016.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/09/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Routine Outcome Monitoring (ROM) has become part of the treatment process in mental health care. However, studies have indicated that few clinicians in psychiatry use the outcome of ROM in their daily work. The aim of this study was to explore the degree of ROM use in clinical practice as well as the explanatory factors of this use. METHODS In the Northern Netherlands, a ROM-protocol (ROM-Phamous) for patients with a psychotic disorder has been implemented. To establish the degree of ROM-Phamous use in clinical practice, the ROM results of patients (n=204) were compared to the treatment goals formulated in their treatment plans. To investigate factors that might influence ROM use, clinicians (n=32) were asked to fill out a questionnaire about ROM-Phamous. RESULTS Care domains that were problematic according to the ROM-Phamous results were mentioned in the treatment plan in 28% of cases on average (range 5-45%). The use of ROM-Phamous in the treatment process varies considerably among clinicians. Most of the clinicians find ROM-Phamous both useful and important for good clinical practice. In contrast, the perceived ease-of-use is low and most clinicians report insufficient time to use ROM-Phamous. CONCLUSIONS More frequent ROM use should be facilitated in clinicians. This could be achieved by improving the fit with clinical routines and the ease-of-use of ROM systems. It is important for all stakeholders to invest in integrating ROM in clinical practice. Eventually, this might improve the diagnostics and treatment of patients in mental health care.
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Affiliation(s)
- M Tasma
- Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, The Netherlands.
| | - E J Liemburg
- Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, The Netherlands
| | - H Knegtering
- Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, The Netherlands
| | - P A E G Delespaul
- Maastricht University, Faculty of Psychiatry & Psychology, Maastricht, The Netherlands; Mondriaan Mental Health Trust, Heerlen-Maastricht, The Netherlands
| | - A Boonstra
- University of Groningen, Faculty of Economics and Business, Groningen, The Netherlands
| | - S Castelein
- Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Rob Giel Research Centre, Groningen, The Netherlands
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Tasma M, Swart M, Wolters G, Liemburg EJ, Bruggemans R, Knegtering H, Castelein S. [Clinical application of ROM in psychosis]. Ned Tijdschr Geneeskd 2017; 161:D845. [PMID: 28325158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM The use of 'routine outcome monitoring' (ROM) in mental health care has increased widely during the past decade. However, little is known about the use of ROM outcome in daily clinical practice. We investigated to what extent ROM results were reflected in psychotic patients' treatment plans. DESIGN Cross-sectional study. METHOD The ROM-Phamous, a ROM-protocol for patients with psychotic disorders in which data is collected on the basis of interviews, questionnaires and physical examination was implemented in the northern Netherlands. A random sample of 100 patients was extracted from the 2010 ROM database (n = 1040), from which we determined the prevalence of a number of problem areas. We then investigated whether these problems were reflected in patients' treatment plans. RESULTS The sample consisted of 63 men and 37 women, with a mean age of 44 years and a mean duration of illness of 18 years. The prevalence of symptoms and psychosocial problems was 13-37%; the prevalence of cardiovascular risk factors was 11-86%. The majority of problems identified with ROM were not reflected in patients' treatment plans; the opposite also occurred: psychosocial problems, in particular, mentioned in the treatment plans were not always identified with ROM. CONCLUSION ROM and treatment should ideally be integrated in mental-health services, but currently appear to be separate processes. If improvement of integration of ROM and clinical practice succeeds it could lead to improvement of care for psychiatric patients. Further investigation is warranted. Conflict of interest and financial support: ICMJE forms provided by the authors are available online along with the full text of this article.
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Affiliation(s)
- M Tasma
- * Dit onderzoek werd eerder gepubliceerd in BMC Psychiatry (2016;16:107) met als titel 'Do routine outcome monitoring results translate to clinical practice? A cross-sectional study in patients with a psychotic disorder'. Afgedrukt met toestemming
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Tasma M, Swart M, Wolters G, Liemburg E, Bruggeman R, Knegtering H, Castelein S. Do routine outcome monitoring results translate to clinical practice? A cross-sectional study in patients with a psychotic disorder. BMC Psychiatry 2016; 16:107. [PMID: 27091333 PMCID: PMC4836179 DOI: 10.1186/s12888-016-0817-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/10/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of Routine Outcome Monitoring (ROM) in mental health care has increased widely during the past decade. Little is known, however, on the implementation and applicability of ROM outcome in daily clinical practice. In the Netherlands, an extensive ROM-protocol for patients with psychotic disorders has been implemented over the last years (ROM-Phamous). The current study investigated to what extent ROM results translate to daily clinical practice. Therefore, we investigated whether clinical problems as identified with ROM were detected and used in the treatment of patients with psychotic disorders. METHODS Out of the ROM database of 2010 (n = 1040), a random sample of 100 patients diagnosed with a psychotic disorder was drawn. ROM-data used in this study included a physical examination, laboratory tests, interviews and self-report questionnaires. Based on these data, the prevalence of positive and negative symptoms, psychosocial problems and cardiovascular risk factors was determined. Next, we investigated whether these problems, as identified with ROM, were reflected in the treatment plans of patients, as an indication of the use of ROM in clinical practice. RESULTS The sample consisted of 63 males and 37 females. The mean age was 44 and the mean duration of illness was 17.7 years. The prevalence of positive and negative symptoms, psychosocial problems and cardiovascular risk factors ranged from 11 to 86 %. In the majority of cases, problems as identified with ROM were not reflected in the treatment plans of patients. CONCLUSIONS We found a substantial discrepancy between the ROM measurements and the treatment plans, i.e. low rates of detection of symptoms, psychosocial problems and cardiovascular risk factors in the treatment plans, even though these problems were identified with ROM. The opposite occurred as well, where problems were reflected in the treatment plans but not identified with ROM. Thus, ROM and daily clinical practice appear to be two separate processes, whereas ideally they should be integrated. Strong efforts should be made to integrate ROM and consequent treatment activities. Such integration may help to provide patients with adequate and customized care and simultaneously minimize under- and over-treatment.
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Affiliation(s)
- Magda Tasma
- />Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marte Swart
- />Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert Wolters
- />Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edith Liemburg
- />Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henderikus Knegtering
- />Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stynke Castelein
- />Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- />Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Castelein S, Tasma M, Swart M, Wolters G, Bruggeman R, Knegtering H. Do Schizophrenia Patients Receive the Care They Need? From Routine Outcome Monitoring to Evidence Based Treatment. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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