Patient, family and provider views of measurement-based care in an early-psychosis intervention programme

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Abstract

Background

Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice.

Aims

This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre.

Method

Researchers conducted qualitative semi-structured interviews with patients ( n = 15), family members ( n = 7), case managers ( n = 8) and psychiatrists ( n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory.

Results

Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool.

Conclusions

This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.

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Most cited references 55

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

A Tong, P SAINSBURY, J. Craig (2007)

Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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Standards for reporting qualitative research: a synthesis of recommendations.

Bridget O’Brien, Ilene Harris, Thomas Beckman … (2014)

Standards for reporting exist for many types of quantitative research, but currently none exist for the broad spectrum of qualitative research. The purpose of the present study was to formulate and define standards for reporting qualitative research while preserving the requisite flexibility to accommodate various paradigms, approaches, and methods.

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Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.

Madhukar Trivedi, A Rush, Stephen R Wisniewski … (2006)

Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in "real world" patients are not established. The authors' primary objectives in this study were to evaluate the effectiveness of citalopram, an SSRI, using measurement-based care in actual practice, and to identify predictors of symptom remission in outpatients with major depressive disorder. This clinical study included outpatients with major depressive disorder who were treated in 23 psychiatric and 18 primary care "real world" settings. The patients received flexible doses of citalopram prescribed by clinicians for up to 14 weeks. The clinicians were assisted by a clinical research coordinator in the application of measurement-based care, which included the routine measurement of symptoms and side effects at each treatment visit and the use of a treatment manual that described when and how to modify medication doses based on these measures. Remission was defined as an exit score of or=50% in baseline QIDS-SR score. Nearly 80% of the 2,876 outpatients in the analyzed sample had chronic or recurrent major depression; most also had a number of comorbid general medical and psychiatric conditions. The mean exit citalopram dose was 41.8 mg/day. Remission rates were 28% (HAM-D) and 33% (QIDS-SR). The response rate was 47% (QIDS-SR). Patients in primary and psychiatric care settings did not differ in remission or response rates. A substantial portion of participants who achieved either response or remission at study exit did so at or after 8 weeks of treatment. Participants who were Caucasian, female, employed, or had higher levels of education or income had higher HAM-D remission rates; longer index episodes, more concurrent psychiatric disorders (especially anxiety disorders or drug abuse), more general medical disorders, and lower baseline function and quality of life were associated with lower HAM-D remission rates. The response and remission rates in this highly generalizable sample with substantial axis I and axis III comorbidity closely resemble those seen in 8-week efficacy trials. The systematic use of easily implemented measurement-based care procedures may have assisted in achieving these results.

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Author and article information

Journal

Journal ID (nlm-ta): BJPsych Open

Journal ID (iso-abbrev): BJPsych Open

Journal ID (publisher-id): BJO

Title: BJPsych Open

Publisher: Cambridge University Press (Cambridge, UK )

ISSN (Electronic): 2056-4724

Publication date (Electronic, collection): September 2021

Publication date (Electronic): 17 September 2021

Volume: 7

Issue: 5

Electronic Location Identifier: e171

Affiliations

[1]Department of Psychiatry, University of Toronto , Canada

[2]Department of Psychiatry, University of Toronto , Canada; and University Health Network , Canada

[3]Centre for Addiction and Mental Health , Canada

[4]Department of Psychiatry, University of Toronto , Canada

[5]Centre for Addiction and Mental Health , Canada

[6]Centre for Addiction and Mental Health , Canada; and Mental Health and Addictions Research Program, Institute for Clinical Evaluative Science (ICES) , Canada

[7]Centre for Addiction and Mental Health , Canada

[8]Department of Psychiatry, University of Toronto , Ontario; Centre for Addiction and Mental Health , Canada; and Department of Family and Community Medicine, University of Toronto , Canada

[9]Department of Psychiatry, University of Toronto , Canada; and Centre for Addiction and Mental Health , Canada

[10]Department of Psychiatry, University of Toronto , Canada; Centre for Addiction and Mental Health , Canada; and Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research Canada

Author notes

Correspondence: Ari B. Cuperfain. Email: ari.cuperfain@ 123456mail.utoronto.ca

Author information

Ari B. Cuperfain https://orcid.org/0000-0001-9457-9751

Suze G. Berkhout https://orcid.org/0000-0002-8827-3489

Nicole Kozloff https://orcid.org/0000-0003-1389-1351

Paul Kurdyak https://orcid.org/0000-0001-8115-7437

Sophie Soklaridis https://orcid.org/0000-0001-5119-8473

Juveria Zaheer https://orcid.org/0000-0001-5071-8078

Article

Publisher Item ID: S205647242101005X

DOI: 10.1192/bjo.2021.1005

PMC ID: 8485347

SO-VID: 4117ed28-6d59-44d1-874f-fc2f0b1e4e31

License:

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 01 May 2021

Date revision received : 27 June 2021

Date accepted : 18 August 2021

Page count

Tables: 3, References: 57, Pages: 9

Funding

Funded by: Slaight Family Centre for Youth in Transition

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Patient, family and provider views of measurement-based care in an early-psychosis intervention programme

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Special feature: Methodological Innovations in Qualitative Educational Research

Most cited references 55

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

Standards for reporting qualitative research: a synthesis of recommendations.

Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.

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Cited by 6

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