Tag: measurement-based care

Reading of the Week: Measurement-based Care – What’s the Evidence? Also, Goldbloom on the Joy of Jabbing

November 4, 2021 /

From the Editor

Well, he looks better.

So often our conversations about patients – in our emergency rooms, wards, and clinics – focus on soft evidence of improvement. No wonder: psychiatry lacks biomarkers. And so, while our colleagues in medicine talk about blood sugars and white blood cell counts, we often discuss other things, like how our patients look and sound.

The promise of measurement-based care: objective evidence of change (or lack thereof). The idea is having a moment, with more and more interest. But what does the literature say?

In the first selection, Maria Zhu (of the University of British Columbia) and her colleagues consider RCTs. In a systematic review and meta-analysis, they look at the efficacy of measurement-based care for depressive disorders. They conclude: “Although benefits for clinical response are unclear, MBC is effective in decreasing depression severity, promoting remission, and improving medication adherence in patients with depressive disorders treated with pharmacotherapy. The results are limited by the small number of included trials, high risk of bias, and significant study heterogeneity.” We discuss the big paper.

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The pandemic has changed much with day-to-day practice, including with the rapid virtualization of mental health care. Remember a time when you didn’t need to talk about “being on mute?” And some psychiatrists have been on the front lines of the vaccine effort. In the second selection, Dr. David Goldbloom (of the University of Toronto) writes about his experiences working in a vaccine clinic. His Toronto Lifeessay details the YouTube video he watched to remind himself of how to administer shots, his family ties to vaccinations, and his fondness for the work. “I will always be grateful to have experienced the joy of jabbing.”

DG

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Reading of the Week: Measurement-based Care – Big Idea, Not-So-Big Reality

January 17, 2019 /

From the Editor

Imagine the excitement if a new antidepressant came to market that boasted that it could achieve the symptom reduction of other antidepressants in about half the time, yet had no significant new side effects.

There is no new antidepressant, but there is a study to mull: In 2015, The American Journal of Psychiatry published a paper on measurement-based care for people with depression, and the patients in the measurement group achieved remission in about half the time compared to people seeing a psychiatrist without the guidance of measurement. Though the paper has limitations, it also suggests the incredible potential of measurement-based care.

The measuring tape isolated on white backgroundThe measuring tape isolated on white background

In the first selection, we consider a new review paper published in JAMA Psychiatry. Kaiser Permanente Washington Health Research Institute’s Cara C. Lewis and her co-authors contemplate the potential of measurement-based care – and its reality (greatly underused). They make six points of observation and discussion before going on to propose an agenda.

In the second selection, we look at a paper by the University of Pennsylvania’s David W. Oslin and his co-authors who use survey data to consider the use of measurement-based care in a paper published by Psychiatric Services.

DG

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Reading of the Week: Can We Predict Relapse in Depression? The Judd et al. Paper from The American Journal of Psychiatry

January 12, 2017 /

From the Editor

Is he going to get sick again?

It’s a question that we often ask when a patient overcomes depression and happily leaves our office. For many patients, depression is a chronic illness – and so, remission is followed by relapse. Is it possible to predict patients with depression who are in remission but at risk of relapse?

Can we predict a future relapse – or is this an exercise in fortune-telling?

This week’s Reading is a paper from The American Journal of Psychiatry. Drawing on a long-term study, they look at the pattern of acute illness, remission, and relapse. Using statistical analyses, the authors seek to find a way of predicting relapse.

Spoiler alert: they do.

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Reading of the Week: The Future of Psychiatry – Part II of II

December 8, 2016 /

From the Editor

Is mental health becoming too technical (and forgetting patients as a result)?

The future of us clinicians?

This is the second Reading in a two-part series considering the future of mental health – not in terms of distant developments like biomarkers and genetically-tailored drugs – but rather by looking at measurement-based care and the evolution of the field.

Last week, measurement-based care.

This week, the end of the art of care?

This week, we look at an editorial The British Journal of Psychiatry that warns against physicians becoming “well treated skilled workers.”

And, continuing the consideration of ‘the future,’ we also consider a new paper that has received much attention. Can a web-based intervention help with insomnia? Spoiler alert – as The New York Times reported last week, “more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.”

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Reading of the Week: The Future of Psychiatry – Part I of II

December 2, 2016 /

From the Editor

Should mental health clinicians embrace measurement-based care? Or is mental health becoming too technical (and forgetting patients as a result)?

The future?

When we speak about the future of mental health, we often think in terms of biomarkers and genetically-tailored drugs. And while they may be part of the distant future, can we improve clinical work in the near future?

Over the next two weeks, we will mull the future of psychiatry in terms of practice and measurement-based care. Measurement-based care has been defined simply by Scott and Lewis as “practice of basing clinical care on client data collected throughout treatment.”

This week, measurement-based care.

Next week, the end of the art of care?

While these two Readings were published in two different journals, they seek to address the future of the field, perhaps in somewhat contrasting ways.

This week, we look at a new paper published in the Psychiatric Services that offers a review of measurement-based care studies.

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Reading of the Week: Depression and Measurement-Based Care (Depression: Week 1 of 3)

September 10, 2015 /

Major depression is common, leading to marked suffering for patients and families and causing physical and mental disability, with a substantial economic burden. Although major depression is prevalent across different cultures and effective pharmacological and psychosocial interventions are available, low remission rates in clinical practice are discouraging. Poor outcomes are related to inadequate dose and duration of pharmacotherapy, poor treatment adherence, high dropout, and frequent as well as unnecessary medication changes. In addition, inconsistency of treatment strategies among clinicians is common. Even in current, guideline-driven practice, there are often wide variations in clinicians’ behaviors, resulting in practice bias rather than a tailored and individualized treatment algorithm.

So opens a new paper that has a large goal: trying to reduce that “wide variation” and improve patient care.

This week’s Reading: “Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters” by Tong Guo et al., just published online (and ahead of print) by The American Journal of Psychiatry.

Find the paper here:

http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2015.14050652

Here’s a quick summary: big study, big journal, and big implications for depression management (and, yes, your patients). In a head-to-head comparison, patients did better when depression management included an algorithm for medications rather than regular psychiatrist care. Continue reading