1
|
O'Brien VC, Kablinger AS, Ko H, Jones SB, McNamara RS, Phenes AR, Hankey MS, Gatto AJ, Tenzer MM, Sharp HD, Cooper LD. Use of Patient-Reported Outcome Measures to Assess the Effectiveness of Hybrid Psychiatric Visits. Psychiatr Serv 2024:appips20230355. [PMID: 38863328 DOI: 10.1176/appi.ps.20230355] [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] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Little empirical evidence exists to support the effectiveness of hybrid psychiatric care, defined as care delivered through a combination of telephone, videoconferencing, and in-person visits. The authors aimed to investigate the effectiveness of hybrid psychiatric care compared with outpatient waitlist groups, assessed with patient-reported outcome measures (PROMs). METHOD Participants were recruited from an adult psychiatry clinic waitlist on which the most common primary diagnoses were unipolar depression, generalized anxiety disorder, and bipolar disorder. Patients (N=148) were randomly assigned to one of two waitlist groups that completed PROMs once or monthly before treatment initiation. PROMs were used to assess symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and daily psychological functioning (Brief Adjustment Scale-6 [BASE-6]). Patient measures were summarized descriptively with means, medians, and SDs and then compared by using the Kruskal-Wallis test; associated effect sizes were calculated. PROM scores for patients who received hybrid psychiatric treatment during a different period (N=272) were compared with scores of the waitlist groups. RESULTS PROM assessments of patients who engaged in hybrid care indicated significant improvements in symptom severity compared with the waitlist groups, regardless of the number of PROMs completed while patients were on the waitlist. Between the hybrid care and waitlist groups, the effect size for the PHQ-9 score was moderate (d=0.66); effect sizes were small for the GAD-7 (d=0.46) and BASE-6 (d=0.45) scores. CONCLUSIONS The findings indicate the clinical effectiveness of hybrid care and that PROMs can be used to assess this effectiveness.
Collapse
Affiliation(s)
- Virginia C O'Brien
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Hayoung Ko
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Sydney B Jones
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Robert S McNamara
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Ashlie R Phenes
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Maria Stack Hankey
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Alyssa J Gatto
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Martha M Tenzer
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Hunter D Sharp
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Lee D Cooper
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| |
Collapse
|
2
|
Aldis R, Rosenfeld LC, Mulvaney-Day N, Lanca M, Zona K, Lam JA, Asfour J, Meltzer JC, Leff HS, Fulwiler C, Wang P, Progovac AM. Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition. Learn Health Syst 2024; 8:e10416. [PMID: 38883875 PMCID: PMC11176570 DOI: 10.1002/lrh2.10416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation. Methods This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites. Results Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients. Conclusions There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.
Collapse
Affiliation(s)
- Rajendra Aldis
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Lisa C Rosenfeld
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Margaret Lanca
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Kate Zona
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Jeffrey A Lam
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Julia Asfour
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - Jonah C Meltzer
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - H Stephen Leff
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Carl Fulwiler
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Philip Wang
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Ana M Progovac
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| |
Collapse
|
3
|
de Jong K, Douglas S, Wolpert M, Delgadillo J, Aas B, Bovendeerd B, Carlier I, Compare A, Edbrooke-Childs J, Janse P, Lutz W, Moltu C, Nordberg S, Poulsen S, Rubel JA, Schiepek G, Schilling VNLS, van Sonsbeek M, Barkham M. Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01381-3. [PMID: 38733413 DOI: 10.1007/s10488-024-01381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.
Collapse
Affiliation(s)
- Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Miranda Wolpert
- Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Benjamin Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Dimence, Center for mental health care, Deventer, The Netherlands
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Samuel Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian A Rubel
- Institute of Psychology, University of Osnabrück, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
4
|
Connors EH, Childs AW, Douglas S, Jensen-Doss A. Data-Informed Communication: How Measurement-Based Care Can Optimize Child Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01372-4. [PMID: 38662178 DOI: 10.1007/s10488-024-01372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/26/2024]
Abstract
Measurement-based care (MBC) research and practice, including clinical workflows and systems to support MBC, are grounded in adult-serving mental health systems. MBC research evidence is building in child and adolescent services, but MBC practice is inherently more complex due to identified client age, the family system and the need to involve multiple reporters. This paper seeks to address a gap in the literature by providing practical guidance for youth-serving clinicians implementing MBC with children and their families. We focus on MBC as a data-informed, client-centered communication process, and present three key strategies to enhance usual care child and adolescent psychotherapy via developmentally-appropriate MBC. These strategies include (1) go beyond standardized measures; (2) lean into discrepancies; and (3) get curious together. Case-based examples drawn from various child-serving settings illustrate these key strategies of MBC in child psychotherapy.
Collapse
Affiliation(s)
| | - Amber W Childs
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Susan Douglas
- Department of Leadership, Policy, and Organizations, Vanderbilt University, Peabody College, Nashville, TN, USA
| | | |
Collapse
|
5
|
Donelan J, Douglas S, Willson A, Lester T, Daly S. Implementing Measurement-Based Care in a Youth Partial Hospital Setting: Leveraging Feedback for Sustainability. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01358-2. [PMID: 38575735 DOI: 10.1007/s10488-024-01358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/06/2024]
Abstract
This paper describes the successful implementation of Measurement-Based Care (MBC) within a Partial Hospitalization Program (PHP) for children and adolescents. Measurement-based care (MBC), the practice of using patient-reported measures routinely to inform decision-making, is associated with improved clinical outcomes for behavioral health patients (Jong et al., Clinical Psychology Review 85, 2021; Fortney & Sladek, 2015). MBC holds great promise in partial hospital programs (PHP) to improve outcomes, yet implementation strategies are as complex as the setting itself. This paper provides a case study example of MBC implementation in a PHP for youth. Over the course of 18 months, an interdisciplinary staff of approximately 20 behavioral health professionals provided partial hospitalization level of care to 633 (39% in-person, 61% telehealth) youth from ages 5 to 18 years old. MBC in this setting incorporated daily patient self-report and weekly caregiver-reported measurements. This descriptive reconstruction, which includes examples of the data that were used during the implementation project, illustrates specific barriers and facilitators in a successful implementation in the local PHP setting. Implementation strategies to address workflow integration, leadership and supervision, and coaching are described, including evolution of these strategies over the course of implementation. Practical considerations for implementing MBC in youth PHP settings are discussed. Finally, the authors explore the potential relationships between the data-driven MBC model of decision making and the development of resilient organizations.
Collapse
Affiliation(s)
- Jill Donelan
- Department of Psychiatry Baystate Health, Springfield, MA, USA.
- Mirah, Boston, MA, USA.
| | - Susan Douglas
- Department of Leadership, Policy, and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Ariane Willson
- Department of Leadership, Policy, and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Tyrena Lester
- Department of Psychiatry Baystate Health, Springfield, MA, USA
| | - Stephanie Daly
- Department of Psychiatry Baystate Health, Springfield, MA, USA
| |
Collapse
|
6
|
Asbury ET. Telehealth and the COVID-19 Pandemic: Making the Pivot from Offline to Online Therapeutic Interventions. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:686-689. [PMID: 37307034 DOI: 10.1089/cyber.2022.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While the global health crisis was not responsible for the creation of virtual environments, the COVID-19 pandemic has spawned increased interest in the use of virtual technologies in the workplace and beyond. The current review highlights some of the methods, modalities, and outcomes of the pivot from in-person (offline) therapeutic interactions to the mode of telehealth (online) strategies. Global social-distancing mandates were especially troubling for mental health clients accustomed to in-person counseling and psychotherapy. Panic, fear, and isolation only compounded the reality of health and financial concerns. Lessons about the advantages of telehealth therapies during the most recent global health crisis, will help prepare us all for the next Disease X event. The primary aim of this brief report is to inform the reader about recent research on the advantages of telehealth modalities. In particular, an examination of online technologies in the midst of a Disease X milieu (i.e., COVID-19) was explored. While the current review is far from exhaustive, research in general should leave us optimistic about the "new normal" of utilizing online communication strategies in mental health and beyond. While a Disease X event did not directly lead to the creation of virtual meetings, emerging research is beginning to enlighten the positive consequences of making the pivot from offline to online therapeutic interventions.
Collapse
Affiliation(s)
- E Trey Asbury
- Master of Science in Psychology, Lincoln Memorial University, Harrogate, Tennessee, USA
| |
Collapse
|
7
|
Ko H, Gatto AJ, Jones SB, O'Brien VC, McNamara RS, Tenzer MM, Sharp HD, Kablinger AS, Cooper LD. Improving measurement-based care implementation in adult ambulatory psychiatry: a virtual focus group interview with multidisciplinary healthcare professionals. BMC Health Serv Res 2023; 23:408. [PMID: 37101134 PMCID: PMC10132409 DOI: 10.1186/s12913-023-09202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Measurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method. METHODS Semi-structured focus group interviews were conducted with clinicians (n = 18) and staff (n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC. RESULTS The clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice. CONCLUSION The virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.
Collapse
Affiliation(s)
- Hayoung Ko
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
| | - Alyssa J Gatto
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Sydney B Jones
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Virginia C O'Brien
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Robert S McNamara
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Martha M Tenzer
- Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia, USA
| | - Hunter D Sharp
- Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia, USA
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Lee D Cooper
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| |
Collapse
|
8
|
Van Tiem J, Wirtz E, Suiter N, Heeren A, Fuhrmeister L, Fortney J, Reisinger H, Turvey C. The Implementation of Measurement-Based Care in the Context of Telemedicine: Qualitative Study. JMIR Ment Health 2022; 9:e41601. [PMID: 36422884 PMCID: PMC9732750 DOI: 10.2196/41601] [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: 08/01/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Measurement Based Care in Mental Health Initiative launched by the Department of Veterans Affairs in 2016 is an example of an evidence-based practice that uses patient-reported outcome measures (PROMs) to improve patient outcomes. The acceptance of measurement-based care (MBC) among Veterans Affairs providers is relatively high. However, there are barriers to MBC for telehealth providers. Health information technologies might afford opportunities to address some of the barriers related to the uptake of MBC. OBJECTIVE This paper reports on an implementation effort to integrate MBC into mental health care telehealth practice using eHealth solutions. METHODS Qualitative data were generated from 22 semistructured interviews with psychiatrists (n=4), psychologists (n=3), social workers (n=3), nurses (n=6), a pharmacist (n=1), and administrative staff (n=5) who provide telemental health care through a community-based outpatient clinic in the rural Midwestern United States. The interviews were conducted during the pilot phase of an implementation initiative to increase the adoption of MBC by revising clinic workflows to integrate the use of eHealth technologies. Data were analyzed using thematic analysis. RESULTS Time burden and workflow issues were the most common barrier to provider adoption of MBC; sharing and reviewing pencil-and-paper measures and results in the same room was no longer possible in novel telehealth workflows necessitated by the COVID-19 pandemic. Providers voiced concerns about how long it would take to collect, adequately score, interpret, share, and document the PROMs during the telehealth visit. Concerns about time might also correspond to a gap in providers' familiarity with these assessments, greater comfort in assessing symptoms through clinical interviews, and being accustomed to using the assessments as screening tools more so than longitudinal outcome measures. Capacities associated with eHealth technologies may address workflow concerns and promote providers' understanding and use of the measures as tracking tools. CONCLUSIONS The need to use limited appointment time well was a top priority for telemental health providers. eHealth technologies provided operative supports that protect time in appointments by shifting when and how PROMs are collected. Bolstering providers' familiarity with how to use PROMs in the course of treatment may impact providers' buy-in by encouraging them to reconsider how sharing and acting on PROMs could be time well spent.
Collapse
Affiliation(s)
- Jen Van Tiem
- Department of Veterans Affairs, Health Services Research & Development, Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States.,Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - Elizabeth Wirtz
- Department of Veterans Affairs, Health Services Research & Development, Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States.,Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - Natalie Suiter
- Department of Veterans Affairs, Health Services Research & Development, Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States.,Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - Amanda Heeren
- Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, United States.,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Lindsey Fuhrmeister
- Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, United States.,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - John Fortney
- Department of Veterans Affairs, Health Services Research & Development, Center of Innovation for Veteran-Centered and Values-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Heather Reisinger
- Department of Veterans Affairs, Health Services Research & Development, Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States.,Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Carolyn Turvey
- Department of Veterans Affairs, Health Services Research & Development, Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States.,Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, United States.,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| |
Collapse
|
9
|
Weiss MD. A Paradigm for Targeting Functional Impairment as an Outcome in Attention-Deficit/Hyperactivity Disorder. Brain Sci 2022; 12:brainsci12081014. [PMID: 36009077 PMCID: PMC9405930 DOI: 10.3390/brainsci12081014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023] Open
Abstract
Although functional impairment is required for a diagnosis in the DSM 5, the time frame and definition of functional impairment is ambiguous. We present a conceptual review clarifying the difference between functional impairment as a stable trait representing strength or disability in various domains, and functional impairment as secondary to emotional or behavior problems, which is a state sensitive to change with treatment intervention. Functional impairment as a measure of treatment outcome includes both change from baseline and status at the endpoint of treatment. When using a validated measure of function, functional improvement can be defined as the percentage of patients who achieve the Minimal Important Clinical Difference (MCID) and functional remission as the percentage of patients who normalize at treatment endpoint. True treatment remission should be defined as both symptomatic and functional remission.
Collapse
|
10
|
Kablinger AS, Gatto AJ, O'Brien VC, Ko H, Jones S, McNamara RS, Sharp HD, Tenzer MM, Cooper LD. Effects of COVID-19 on Patients in Adult Ambulatory Psychiatry: Using Patient-Rated Outcome Measures and Telemedicine. Telemed J E Health 2022; 28:1421-1430. [PMID: 35167369 PMCID: PMC9587767 DOI: 10.1089/tmj.2021.0642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: To examine the effects of coronavirus disease 2019 (COVID-19) on patients in an academic psychiatric ambulatory clinic, data from a measurement-based care (MBC) system were analyzed to evaluate impacts on psychiatric functioning in patients using telemedicine. Psychiatric functioning was evaluated for psychological distress (brief adjustment scale [BASE]-6), depression (patient health questionnaire [PHQ]-9), and anxiety (generalized anxiety disorder [GAD]-7), including initial alcohol (U.S. alcohol use disorders identification test) and substance use (drug abuse screening test-10) screening. Methods: This observational study included MBC data collected from November 2019 to March 2021. Patient-Reported Outcome Measures (PROMs) were examined to determine changes in symptomatology over the course of treatment, as well as symptom changes resulting from the pandemic. Patients were included in analyses if they completed at least one PROM in the MBC system. Results: A total of 2,145 patients actively participated in the MBC system completing at least one PROM, with engagement ranging from 35.07% to 83.50% depending on demographic factors, where completion rates were significantly different for age, payor status, and diagnostic group. Average baseline scores for new patients varied for the GAD-7, PHQ-9, and BASE-6. Within-person improvements in mental health before and after the pandemic were statistically significant for anxiety, depression, and psychological adjustment. Discussion: MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.
Collapse
Affiliation(s)
- Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Alyssa J Gatto
- Department of Psychology, Brown University, Providence, Rhode Island, USA
| | - Virginia C O'Brien
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Hayoung Ko
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
| | - Sydney Jones
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
| | - Robert S McNamara
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Hunter D Sharp
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, Virginia, USA
| | - Martha M Tenzer
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, Virginia, USA
| | - Lee D Cooper
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
| |
Collapse
|
11
|
Barnett ML, Sigal M, Green Rosas Y, Corcoran F, Rastogi M, Jent JF. Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:630-641. [PMID: 33994769 PMCID: PMC8112899 DOI: 10.1016/j.cbpra.2021.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/19/2021] [Indexed: 12/01/2022]
Abstract
It has been widely recognized that access to mental health treatment is imperative to address current and long-term stressors for children and parents during COVID-19. Internet-delivered Parent-Child Interaction Therapy (iPCIT, previously referred to as I-PCIT) is a strong model for remote service delivery during social distancing restrictions due to its empirical base. However, this treatment modality was not widely implemented before COVID-19, likely due to barriers to providing telehealth services. This mixed methods study conducted a follow-up survey to gather therapist experiences (N = 223) in delivering iPCIT during COVID-19, including qualitative data on the benefits and challenges to delivering iPCIT. The vast majority of therapists (82%) indicated that they transitioned to deliver PCIT via telehealth in response to COVID-19. PCIT caseloads decreased slightly from the first survey to the COVID-19 follow-up survey, but the racial and ethnic composition of caseloads were not significantly different between the two surveys. Of the 183 therapists who transitioned to deliver PCIT via telehealth, 82% expressed interest in continuing to provide iPCIT following the COVID-19 pandemic. Reported benefits of iPCIT included decreased barriers to access and the ability to practice skills within the naturalistic home environment. Challenges to iPCIT were primarily issues with technology as well as other logistical barriers, which could limit engagement for some families. Findings from this study may be beneficial in improving future implementation of iPCIT during and post-COVID-19.
Collapse
|