Routine assessment of patient-reported outcomes in behavioral health: room for improvement

Impact of routine assessment of health-related quality of life coupled with therapeutic information on compliance with endocrine therapy in patients with non-metastatic breast cancer: protocol for a randomized controlled trial

Background

Despite its proven efficacy in reducing recurrence and improving survival, adherence to endocrine therapy (ET) is suboptimal in women with breast cancer (BC). Health-related quality of life (HRQoL) in BC has been widely studied and many positive effects have been highlighted. Recently, a link between HRQoL and compliance with ET has been suggested, which would suggest a potential role for HRQoL assessment in improving compliance with ET. With the advent of digital technologies, electronic collection of HRQoL on a tablet is now possible. Thus, we hypothesize that systematic HRQoL assessment (using a tablet, prior to each consultation, with presentation of scores to clinicians) coupled with therapeutic information could have an impact on 12-month compliance with ET in patients with non-metastatic BC.

Methods

In this study, we will include 342 women with non-metastatic hormone receptor–positive BC with an indication for treatment with ET. Patients will be randomly assigned 1:1 by minimization and stratified by age, stage, type of ET prescribed, and presence of comorbidities (or not) in two arms. The intervention will consist of numerical HRQoL assessment using the CHES (Computer-based Health Evaluation System) software before each consultation (with delivery of scores to clinicians) coupled with therapeutic information. Therapeutic information will consist of three workshops related to understanding the prescription, nutrition, and fatigue. A reminder letter will be sent to patients every month. Patients in the control group will follow standard care. HRQoL will be assessed using a classic “paper-pencil” collection at baseline in both arms to ensure comparability between arms and at 12 months. The primary endpoint is 12-month compliance with ET. Patient satisfaction with care and the clinicians’ perception of the usefulness of routine HRQoL assessment will also be assessed.

Discussion

This study will allow clinicians to identify and better understand the areas in which patients who receive ET have difficulties and thus it will assist clinicians with patient management. Systematic evaluation of HRQoL could provide an additional endpoint for measuring patients’ health status and treatment-related symptoms, including ET. If the results of this study are positive, this intervention could be proposed as an integral part of daily clinical practice in patients who receive ET.

Trial registration

ClinicalTrials.govNCT04176809. Registered Nov. 25, 2019.

Adolescents Are Less Satisfied with Inpatient Psychiatric Care than Their Parents: Does It Matter?

OBJECTIVE

Patient satisfaction is a commonly used measure of healthcare quality. Limited research exists among psychiatric inpatients, especially adolescents, who pose unique challenges. This study sought to (1) concurrently assess adolescents' and parents' satisfaction with treatment and (2) compare their perspectives' association with treatment outcomes.

METHODS

This exploratory study assessed discharged adolescents from a specialty psychiatric hospital. Adolescent patients and parents completed the Perceptions of Care survey (POC), a measure of patient satisfaction. Patients also completed the Youth Self-Report measure, while parents also completed the Child Behavior Checklist-both are used as measures of mental health treatment outcomes.

RESULTS

Adolescents and parents gave favorable overall ratings of care. Adolescents were more critical than their parents, and there was little agreement between them. Adolescents' ratings on the POC frequently related to outcomes, whereas parents' ratings rarely did.

CONCLUSIONS

Ratings of satisfaction with adolescent healthcare can vary depending on whether patients or caregivers are assessed. The discrepancy between them contains value: adolescents' perception may be a better gauge of treatment outcomes and may affect treatment adherence. Future research should examine adolescent-specific concerns in the context of satisfaction with care and relate them to longer term treatment outcomes.

Patient-reported Outcomes in Practice: Clinicians' Perspectives From an Inpatient Psychiatric Setting

The use of patient-reported outcomes (PROs) has become increasingly common. They have been used to assess quality of care and to support policy decisions, but the evidence concerning their utility to improve patient outcomes is inconsistent. A better understanding of clinicians' experience with PROs has the potential to improve their effectiveness. This exploratory, quantitative, and qualitative study investigated the perspectives of clinicians (N=70) from multiple disciplines (psychiatrists, psychologists, social workers, and psychiatric nurses) on the utility of PROs in an inpatient psychiatric setting. During scheduled, monthly, discipline-specific administrative meetings, clinicians in attendance completed a 1-time, 5-item survey. The highest rated item related to the frequency of reviewing outcomes reports; this item was rated higher than all other items (mean±SD, 4.5±1.5), which 37.5% of the participants in the overall sample stated they "always" did. The lowest rated item related to the frequency of conveying the results of the outcomes reports to patients (3.3±1.9), which 20% of participants reported "always" doing; this item was rated lower than all other items (P<0.03). Qualitative analyses were based on 30 comments from 22 clinicians, which resulted in the emergence of 6 themes. The 2 themes that received the highest number of comments related to: (1) the sensitivity and specificity of measures across the PROs platform and (2) the value of the reports in directly influencing treatment decisions. Clinicians' relatively favorable perspective of PROs in practice in this study may be related to the assessment-oriented culture at the study institution. Nonetheless, many barriers to the routine use of PROs exist. Addressing clinician concerns has the potential to improve utilization of this facet of good clinical care.

Consistency and coherence in treatment outcome measures for borderline personality disorder

There is little consensus regarding outcomes assessment in borderline personality disorder treatment trials, making comparisons of results and meta-analytic studies difficult and far less generalizable. The current article highlights a range of measures frequently employed and puts forth a set of recommendations for a core battery of outcome measures in BPD treatment efforts. The proposed core battery aims to be comprehensive while minimizing patient burden, clinician time and costs. The relative brevity of the proposed core battery would engender flexibility for adding specific processes and outcome measures unique to targeted interventions and treatment models.

Horizon 2020 priorities in clinical mental health research: results of a consensus-based ROAMER expert survey

Within the ROAMER project, which aims to provide a Roadmap for Mental Health Research in Europe, a two-stage Delphi survey among 86 European experts was conducted in order to identify research priorities in clinical mental health research. Expert consensus existed with regard to the importance of three challenges in the field of clinical mental health research: (1) the development of new, safe and effective interventions for mental disorders; (2) understanding the mechanisms of disease in order to be able to develop such new interventions; and (3) defining outcomes (an improved set of outcomes, including alternative outcomes) to use for clinical mental health research evaluation. Proposed actions involved increasing the utilization of tailored approaches (personalized medicine), developing blended eHealth/mHealth decision aids/guidance tools that help the clinician to choose between various treatment modalities, developing specific treatments in order to better target comorbidity and (further) development of biological, psychological and psychopharmacological interventions. The experts indicated that addressing these priorities will result in increased efficacy and impact across Europe; with a high probability of success, given that Europe has important strengths, such as skilled academics and a long research history. Finally, the experts stressed the importance of creating funding and coordinated networking as essential action needed in order to target the variety of challenges in clinical mental health research.

Clinicians' perspectives on a Web-based system for routine outcome monitoring in old-age psychiatry in the Netherlands

BACKGROUND

In health care, the use of physical parameters to monitor physical disease progress is common. In mental health care, the periodic measurement of a client's functioning during treatment, or routine outcome monitoring, has recently become important. Online delivery of questionnaires has the potential to reduce clinicians' resistance to the implementation of routine outcome monitoring. Online delivery enables clinicians to receive results on a questionnaire in a graphic directly after data entry. This gives them insight into the progress of a client at a single glance.

OBJECTIVE

To explore clinicians' perspectives on a routine outcome monitoring procedure where questionnaires and feedback on scores were delivered online. Questionnaires could also be filled out on paper and then entered into the online system by a research assistant.

METHODS

In 2009 we sent an online survey, consisting of five yes-or-no questions and six open-ended questions, to all clinicians in the 14 mental health care organizations working with the routine outcome monitoring system in the Netherlands. Of the 172 clinicians contacted, 80 (47%) opened the link and 70 of these 80 (88%) clinicians completed the survey.

RESULTS

Clinicians seldom used the graphical feedback from the Web-based system, which indicates that direct feedback on scores did not enhance the implementation of routine outcome monitoring. Integration into the electronic patient record and more training on interpretation and implementation of feedback in daily practice were seen as the primary points for further improvement. It was mainly the availability of a research assistant that made the routine outcome monitoring procedure feasible.

CONCLUSIONS

Without a research assistant and training in the interpretation of outcomes, software programs alone cannot ensure effective implementation of monitoring activities in everyday practice.

Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet

BACKGROUND

Ongoing initiatives to filter online health searches exclude consumer-generated content from search returns, though its inferiority compared with professionally controlled content is not demonstrated. The antidepressant escitalopram and the antipsychotic quetiapine have ranked over the last 5 years as top-selling agents in their respective drug classes. Both drugs have various off-label mental health and non-mental health uses, ranging from the relief of insomnia and migraines to the treatment of severe developmental disorders.

OBJECTIVE

Our objective was to describe the most frequently reported effects of escitalopram and quetiapine in online consumer reviews, to compare them with effects described in professionally controlled commercial health websites, and to gauge the usability of online consumer medication reviews.

METHODS

A stratified simple random sample of 960 consumer reviews was selected from all 6998 consumer reviews of the two drugs in 2 consumer-generated (www.askapatient.com and www.crazymeds.us) and 2 professionally controlled (www.webmd.com and www.revolutionhealth.com) health websites. Professional medication descriptions included all standard information on the medications from the latter 2 websites. All textual data were inductively coded for medication effects, and intercoder agreement was assessed. Chi-square was used to test for associations between consumer-reported effects and website origination.

RESULTS

Consumers taking either escitalopram (n = 480) or quetiapine (n = 480) most frequently reported symptom improvement (30.4% or 146/480, 24.8% or 119/480) or symptom worsening (15.8% or 76/480, 10.2% or 49/480), changes in sleep (36% or 173/480, 60.6% or 291/480) and changes in weight and appetite (22.5% or 108/480, 30.8% or 148/480). More consumers posting reviews on consumer-generated rather than professionally controlled websites reported symptom worsening on quetiapine (17.3% or 38/220 versus 5% or 11/220, P < .001), while more consumers posting on professionally controlled websites reported symptom improvement (32.7% or 72/220 versus 21.4% or 47/220, P = .008). Professional descriptions more frequently listed physical adverse effects and warnings about suicidal ideation while consumer reviews emphasized effects disrupting daily routines and provided richer descriptions of effects in context. The most recent 20 consumer reviews on each drug from each website (n = 80) were comparable to the full sample of reviews in the frequency of commonly reported effects.

CONCLUSION

Consumer reviews and professional medication descriptions generally reported similar effects of two psychotropic medications but differed in their descriptions and in frequency of reporting. Professional medication descriptions offer the advantage of a concise yet comprehensive listing of drug effects, while consumer reviews offer greater context and situational examples of how effects may manifest in various combinations and to varying degrees. The dispersion of consumer reviews across websites limits their integration, but a brief browsing strategy on the two target medications nonetheless retrieved representative consumer content. Current strategies for filtering online health searches to return only trusted or approved websites may inappropriately address the challenge to identify quality health sources on the Internet because such strategies unduly limit access to an entire complementary source for health information.