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Do routine outcome monitoring results translate to clinical practice? A cross-sectional study in patients with a psychotic disorder.

Tasma M, Swart M, Wolters G, Liemburg E, Bruggeman R, Knegtering H, Castelein S - BMC Psychiatry (2016)

Bottom Line: The current study investigated to what extent ROM results translate to daily clinical practice.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.Such integration may help to provide patients with adequate and customized care and simultaneously minimize under- and over-treatment.

View Article: PubMed Central - PubMed

Affiliation: Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands. m.tasma@lentis.nl.

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.

No MeSH data available.


Related in: MedlinePlus

Problems detected with ROM and the treatment plan. This graph depicts whether problems were detected with ROM and whether they were reflected in the treatment plans of patients. The investigated problem areas are depicted on the x-as and the amount of patients is depicted on the y-as. Patients with incomplete information (missing ROM-data and/or missing treatment plans) are not shown in the graph. The grey part of the bars indicates the amount of patients of which a problem was neither detected with ROM, nor reflected in the treatment plan. The orange part of the bars indicates the amount of patients of which a problem was not detected with ROM, but was reflected in the treatment plan. The red part of the bars indicates the amount of patients of which a problem was detected with ROM, but was not reflected in the treatment plan. The green part of the bars indicates the amount of patients of which a problem was both detected with ROM and reflected in the treatment plan. (ROM = Routine Outcome Monitoring, TP = treatment plan, + = problem is detected/reflected, − = problem is not detected/reflected)
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Fig1: Problems detected with ROM and the treatment plan. This graph depicts whether problems were detected with ROM and whether they were reflected in the treatment plans of patients. The investigated problem areas are depicted on the x-as and the amount of patients is depicted on the y-as. Patients with incomplete information (missing ROM-data and/or missing treatment plans) are not shown in the graph. The grey part of the bars indicates the amount of patients of which a problem was neither detected with ROM, nor reflected in the treatment plan. The orange part of the bars indicates the amount of patients of which a problem was not detected with ROM, but was reflected in the treatment plan. The red part of the bars indicates the amount of patients of which a problem was detected with ROM, but was not reflected in the treatment plan. The green part of the bars indicates the amount of patients of which a problem was both detected with ROM and reflected in the treatment plan. (ROM = Routine Outcome Monitoring, TP = treatment plan, + = problem is detected/reflected, − = problem is not detected/reflected)

Mentions: The time between the ROM-screening and the draft of the treatment plan ranged from 0 to 18 months (mean = 6.7; sd = 4.9). Figure 1 depicts whether problems were identified with ROM and whether they were reflected in the treatment plan. Only in a small amount of cases problems were both detected with ROM and reflected in the treatment plan (mean = 5; ranging from 1 patient to 16 patients between the different problem areas). In many cases, problems were detected with ROM, but not reflected in the treatment plan. This was especially striking for positive and negative symptoms, overweight, dyslipidaemia and smoking (n = 21; n = 17; n = 43; n = 40; n = 56, respectively). The opposite occurred as well, where problems were not detected with ROM, but were reflected in the treatment plans. This occurred most frequently in problems with social functioning and daily activities (n = 14; n = 34, respectively).Fig. 1


Do routine outcome monitoring results translate to clinical practice? A cross-sectional study in patients with a psychotic disorder.

Tasma M, Swart M, Wolters G, Liemburg E, Bruggeman R, Knegtering H, Castelein S - BMC Psychiatry (2016)

Problems detected with ROM and the treatment plan. This graph depicts whether problems were detected with ROM and whether they were reflected in the treatment plans of patients. The investigated problem areas are depicted on the x-as and the amount of patients is depicted on the y-as. Patients with incomplete information (missing ROM-data and/or missing treatment plans) are not shown in the graph. The grey part of the bars indicates the amount of patients of which a problem was neither detected with ROM, nor reflected in the treatment plan. The orange part of the bars indicates the amount of patients of which a problem was not detected with ROM, but was reflected in the treatment plan. The red part of the bars indicates the amount of patients of which a problem was detected with ROM, but was not reflected in the treatment plan. The green part of the bars indicates the amount of patients of which a problem was both detected with ROM and reflected in the treatment plan. (ROM = Routine Outcome Monitoring, TP = treatment plan, + = problem is detected/reflected, − = problem is not detected/reflected)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836179&req=5

Fig1: Problems detected with ROM and the treatment plan. This graph depicts whether problems were detected with ROM and whether they were reflected in the treatment plans of patients. The investigated problem areas are depicted on the x-as and the amount of patients is depicted on the y-as. Patients with incomplete information (missing ROM-data and/or missing treatment plans) are not shown in the graph. The grey part of the bars indicates the amount of patients of which a problem was neither detected with ROM, nor reflected in the treatment plan. The orange part of the bars indicates the amount of patients of which a problem was not detected with ROM, but was reflected in the treatment plan. The red part of the bars indicates the amount of patients of which a problem was detected with ROM, but was not reflected in the treatment plan. The green part of the bars indicates the amount of patients of which a problem was both detected with ROM and reflected in the treatment plan. (ROM = Routine Outcome Monitoring, TP = treatment plan, + = problem is detected/reflected, − = problem is not detected/reflected)
Mentions: The time between the ROM-screening and the draft of the treatment plan ranged from 0 to 18 months (mean = 6.7; sd = 4.9). Figure 1 depicts whether problems were identified with ROM and whether they were reflected in the treatment plan. Only in a small amount of cases problems were both detected with ROM and reflected in the treatment plan (mean = 5; ranging from 1 patient to 16 patients between the different problem areas). In many cases, problems were detected with ROM, but not reflected in the treatment plan. This was especially striking for positive and negative symptoms, overweight, dyslipidaemia and smoking (n = 21; n = 17; n = 43; n = 40; n = 56, respectively). The opposite occurred as well, where problems were not detected with ROM, but were reflected in the treatment plans. This occurred most frequently in problems with social functioning and daily activities (n = 14; n = 34, respectively).Fig. 1

Bottom Line: The current study investigated to what extent ROM results translate to daily clinical practice.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.Such integration may help to provide patients with adequate and customized care and simultaneously minimize under- and over-treatment.

View Article: PubMed Central - PubMed

Affiliation: Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands. m.tasma@lentis.nl.

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.

No MeSH data available.


Related in: MedlinePlus